HSS Journal

, 7:134 | Cite as

Results of Anatomic Lateral Ankle Ligament Reconstruction with Tendon Allograft

  • Scott J. Ellis
  • Benjamin Roller Williams
  • Helene Pavlov
  • Jonathan Deland
Original Article

Abstract

Chronic ankle instability can be addressed surgically through direct lateral ligament repair, non-anatomic reconstruction, or anatomic reconstruction. The goal of this study was to assess the radiographic, functional, and clinical results of patients undergoing an anatomic lateral ankle ligament reconstruction using an anterior tibial tendon allograft. Eleven patients (12 feet; mean age, 48.9 ± 11.4 years) undergoing lateral ankle ligament reconstruction were followed at a mean of 3.5 ± 1.7 years after surgery (range, 1.2 to 5.0 years). Indications for surgery were previous failed repair (i.e., Broström; one case), hyperlaxity (seven cases), and high-demand patients (four cases). Subjective outcomes including the Foot and Ankle Outcome Score (FAOS), SF-36, and activity level were assessed. Mortise and lateral ankle stress radiographs were performed. The FAOS daily activity and sports activity subscores were 93.4 (range, 77.9 to 100) and 78.6 (range, 30 to 100), respectively. The SF-36v2 physical health and mental health components were 50.4 (range, 30.6 to 65.7) and 45.0 (range, 24.8 to 68.0), respectively. Four patients (five feet) reported no restriction; six patients reported mild restrictions, and one patient reported moderate activity restrictions. Tibiotalar tilt improved significantly from 20.2° to 4.6° after surgery (p < 0.01). The radiographic anterior displacement of the talus from the tibia was 6.5 mm postoperatively. The technique described restores mechanical stability in patients with chronic lateral ankle instability and may be considered in a select group of patients.

Keywords

chronic ankle instability lateral ligaments anatomic ligament reconstruction allograft anterior tibial tendon 

References

  1. 1.
    Garrick JG. The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med. 1977;6:241–242.CrossRefGoogle Scholar
  2. 2.
    Garrick JG. Epidemiology of sports injuries. Presented at Third Annual Sports Medicine Symposium. 1973.Google Scholar
  3. 3.
    Karlsson J, Bergsten T, Lansinger O, Peterson L. Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am. 1988;4:581–588.Google Scholar
  4. 4.
    Karlsson J, Bergsten T, Lansinger O, Peterson L. Surgical treatment of chronic lateral instability of the ankle joint. A new procedure. Am J Sports Med. 1989;2:268–73; discussion 273–4.CrossRefGoogle Scholar
  5. 5.
    Karlsson J, Eriksson BI, Bergsten T, Rudholm O, Sward L. Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint. Am J Sports Med. 1997;1:48–53.CrossRefGoogle Scholar
  6. 6.
    Harrington KD. Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. J Bone Joint Surg Am. 1979;3:354–361.Google Scholar
  7. 7.
    Nakata K, Shino K, Horibe S, Natsu-ume T, Mae T, Ochi T. Reconstruction of the lateral ligaments of the ankle using solvent-dried and gamma-irradiated allogeneic fascia lata. J Bone Joint Surg Br. 2000;4:579–582.CrossRefGoogle Scholar
  8. 8.
    Coughlin MJ, Schenck RC,Jr, Grebing BR, Treme G. Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft. Foot Ankle Int. 2004;4:231–241.Google Scholar
  9. 9.
    Muijs SP, Dijkstra PD, Bos CF. Clinical outcome after anatomical reconstruction of the lateral ankle ligaments using the duquennoy technique in chronic lateral instability of the ankle: A long-term follow-up study. J Bone Joint Surg Br. 2008;1:50–56.Google Scholar
  10. 10.
    Sarrafian SK. Syndesmology. In: Anatomy of the Foot and Ankle. Philadelphia: J.B. Lippincott Company; 1983:143–198.Google Scholar
  11. 11.
    Holmer P, Sondergaard L, Konradsen L, Nielsen PT, Jorgensen LN. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int. 1994;2:72–74.Google Scholar
  12. 12.
    Renstrom PA, Konradsen L. Ankle ligament injuries. Br J Sports Med. 1997;1:11–20.CrossRefGoogle Scholar
  13. 13.
    Brostrom L. Sprained ankles. V. treatment and prognosis in recent ligament ruptures. Acta Chir Scand. 1966;5:537–550.Google Scholar
  14. 14.
    Brostrom L. Sprained ankles. VI. surgical treatment of “chronic” ligament ruptures. Acta Chir Scand. 1966;5:551–565.Google Scholar
  15. 15.
    Gould N, Seligson D, Gassman J. Early and late repair of lateral ligament of the ankle. Foot Ankle. 1980;2:84–89.Google Scholar
  16. 16.
    Chrisman OD, Snook GA. Reconstruction of lateral ligament tears of the ankle. an experimental study and clinical evaluation of seven patients treated by a new modification of the elmslie procedure. J Bone Joint Surg Am. 1969;5:904–912.Google Scholar
  17. 17.
    Watson-Jones R. Recurrent forward dislocation of the ankle joint. J.Bone Joint Surg.Br. 1952;519.Google Scholar
  18. 18.
    Evans DL. Recurrent instability of the ankle; a method of surgical treatment. Proc R Soc Med. 1953;5:343–344.Google Scholar
  19. 19.
    Hollis JM, Blasier RD, Flahiff CM, Hofmann OE. Biomechanical comparison of reconstruction techniques in simulated lateral ankle ligament injury. Am J Sports Med. 1995;6:678–682.CrossRefGoogle Scholar
  20. 20.
    Schmidt R, Cordier E, Bertsch C, Eils E, Neller S, Benesch S, Herbst A, Rosenbaum D, Claes L. Reconstruction of the lateral ligaments: Do the anatomical procedures restore physiologic ankle kinematics?. Foot Ankle Int. 2004;1:31–36.Google Scholar
  21. 21.
    Tohyama H, Beynnon BD, Pope MH, Haugh LD, Renstrom PA. Laxity and flexibility of the ankle following reconstruction with the chrisman-snook procedure. J Orthop Res. 1997;5:707–711.CrossRefGoogle Scholar
  22. 22.
    Anderson ME. Reconstruction of the lateral ligaments of the ankle using the plantaris tendon. J Bone Joint Surg Am. 1985;6:930–934.Google Scholar
  23. 23.
    Boyer DS, Younger AS. Anatomic reconstruction of the lateral ligament complex of the ankle using a gracilis autograft. Foot Ankle Clin. 2006;3:585–595.CrossRefGoogle Scholar
  24. 24.
    Caprio A, Oliva F, Treia F, Maffulli N. Reconstruction of the lateral ankle ligaments with allograft in patients with chronic ankle instability. Foot Ankle Clin. 2006;3:597–605.CrossRefGoogle Scholar
  25. 25.
    Horibe S, Shino K, Taga I, Inoue M, Ono K. Reconstruction of lateral ligaments of the ankle with allogeneic tendon grafts. J Bone Joint Surg Br. 1991;5:802–805.Google Scholar
  26. 26.
    Okuda R, Kinoshita M, Morikawa J, Jotoku T, Abe M. Reconstruction for chronic lateral ankle instability using the palmaris longus tendon: Is reconstruction of the calcaneofibular ligament necessary?. Foot Ankle Int. 1999;11:714–720.Google Scholar
  27. 27.
    Pagenstert GI, Valderrabano V, Hintermann B. Lateral ankle ligament reconstruction with free plantaris tendon graft. Tech F and A Surg. 2005;2:104–112.Google Scholar
  28. 28.
    Paterson R, Cohen B, Taylor D, Bourne A, Black J. Reconstruction of the lateral ligaments of the ankle using semi-tendinosis graft. Foot Ankle Int. 2000;5:413–419.Google Scholar
  29. 29.
    Sugimoto K, Takakura Y, Kumai T, Iwai M, Tanaka Y. Reconstruction of the lateral ankle ligaments with bone-patellar tendon graft in patients with chronic ankle instability: A preliminary report. Am J Sports Med. 2002;3:340–346.Google Scholar
  30. 30.
    McGarvey WC, Clanton TO. Lateral ankle ligament reconstruction using allograft and interference screw fixation. In: Easley ME, Weisel SW, eds. Operative Techniques in Foot and Ankle Surgery. Philadelphia: Wolters Kluwer, Lippincott Williams and Wilkins; 2010:851–859.Google Scholar
  31. 31.
    Roos EM, Brandsson S, Karlsson J. Validation of the foot and ankle outcome score for ankle ligament reconstruction. Foot Ankle Int. 2001;10:788–794.Google Scholar
  32. 32.
    Messer TM, Cummins CA, Ahn J, Kelikian AS. Outcome of the modified brostrom procedure for chronic lateral ankle instability using suture anchors. Foot Ankle Int. 2000;12:996–1003.Google Scholar
  33. 33.
    Nimon GA, Dobson PJ, Angel KR, Lewis PL, Stevenson TM. A long-term review of a modified evans procedure. J Bone Joint Surg Br. 2001;1:14–18.CrossRefGoogle Scholar
  34. 34.
    Beighton P, Horan F. Orthopaedic aspects of the ehlers-danlos syndrome. J Bone Joint Surg Br. 1969;3:444–453.Google Scholar
  35. 35.
    Coughlin MJ. Arthrodesis of the first metatarsophalangeal joint with mini-fragment plate fixation. Orthopedics. 1990;9:1037–1044.Google Scholar
  36. 36.
    Schenck RC,Jr, Coughlin MJ. Lateral ankle instability and revision surgery alternatives in the athlete. Foot Ankle Clin. 2009;2:205–214.CrossRefGoogle Scholar
  37. 37.
    Lohrer H, Nauck T, Arentz S, Scholl J. Observer reliability in ankle and calcaneocuboid stress radiography. Am J Sports Med. 2008;6:1143–1149.CrossRefGoogle Scholar
  38. 38.
    Sarrafian SK. Functional anatomy of the foot and ankle. In: Anatomy of the Foot and Ankle. 1st ed. Philadelphia, PA: J.B. Lippincott Company; 1983:375–425.Google Scholar
  39. 39.
    Quatman CE, Ford KR, Myer GD, Paterno MV, Hewett TE. The effects of gender and pubertal status on generalized joint laxity in young athletes. J Sci Med Sport. 2008;3:257–263.CrossRefGoogle Scholar
  40. 40.
    Boyle KL, Witt P, Riegger-Krugh C. Intrarater and interrater reliability of the beighton and horan joint mobility index. J Athl Train. 2003;4:281–285.Google Scholar
  41. 41.
    Goksel Karatepe A, Gunaydin R, Kaya T, Karlibas U, Ozbek G. Validation of the turkish version of the foot and ankle outcome score. Rheumatol Int. 2009.Google Scholar
  42. 42.
    Krips R, van Dijk CN, Halasi PT, Lehtonen H, Corradini C, Moyen B, Karlsson J. Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: A multicenter study. Foot Ankle Int. 2001;5:415–421.Google Scholar
  43. 43.
    Ferran NA, Oliva F, Maffulli N. Ankle instability. Sports Med Arthrosc. 2009;2:139–145.CrossRefGoogle Scholar
  44. 44.
    Pagenstert GI, Hintermann B, Knupp M. Operative management of chronic ankle instability: Plantaris graft. Foot Ankle Clin. 2006;3:567–583.CrossRefGoogle Scholar
  45. 45.
    Takao M, Oae K, Uchio Y, Ochi M, Yamamoto H. Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft: A new technique using an interference fit anchoring system. Am J Sports Med. 2005;6:814–823.CrossRefGoogle Scholar
  46. 46.
    Boyer MI, Bowen V, Weiler P. Reconstruction of a severe grinding injury to the medial malleolus and the deltoid ligament of the ankle using a free plantaris tendon graft and vascularized gracilis free muscle transfer: Case report. J Trauma. 1994;3:454–457.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2011

Authors and Affiliations

  • Scott J. Ellis
    • 1
  • Benjamin Roller Williams
    • 1
  • Helene Pavlov
    • 2
  • Jonathan Deland
    • 1
  1. 1.Department of Foot and Ankle SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Radiology and ImagingHospital for Special SurgeryNew YorkUSA

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