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Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments using a semitendinosus tendon allograft and interference screws

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate the functional and radiographic outcomes of a novel surgical technique devised to treat chronic lateral ankle instability. The technique involves direct repair of the anterior talofibular ligament and anatomic reconstructions of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) using a free semitendinosus tendon allograft and interference screws.

Methods

This retrospective study involved a review of the records of 27 patients (28 ankles) with chronic lateral ankle instability treated from 2007 to 2009. VAS pain scores, AOFAS scores, Karlsson–Peterson ankle scores (24 ankles), and patient satisfaction were evaluated at median of 19 (12–26) months postoperatively. Radiographically, talar tilt angles and anterior talar translation were assessed in pre- and postoperative ankle stress views.

Results

Median patient age at surgery was 36.5 (16–57) years. Median VAS pain score decreased from 6 (3–9) to 2 (0–4) (P < 0.05), and median AOFAS score improved from 63 (41–84) to 91 (81–100) preoperatively to final follow-up (P < 0.05). Median Karlsson–Peterson score also significantly improved from 55 (32–77) to 80 (59–100) (P < 0.05), whereas talar tilt decreased from 17.8° (10.0°–25.5°) to 6.7° (0.3°–13.0°) and the mean anterior drawer test decreased from 10.0 mm (0.6–19.4) to 4.5 mm (0.2–8.7) (P < 0.05). Eighty-eight percent (21/24) were satisfied with surgery. No complication, such as subtalar stiffness or recurrent instability, was encountered.

Conclusions

The described technique, which involves anatomic reconstruction of the ATFL and CFL using the semitendinosus tendon and interference screws with direct repair of the capsule, is a viable option for treating lateral ankle instability with stable tendon fixation and provides satisfactory clinical outcomes.

Level of evidence

Case-series, Level IV.

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References

  1. Ahlgren O, Larsson S (1989) Reconstruction for lateral ligament injuries of the ankle. J Bone Joint Surg Br 71(2):300–303

    PubMed  CAS  Google Scholar 

  2. Becker HP, Rosenbaum D, Zeithammel G, Gnann R, Bauer G, Gerngross H, Claes L (1996) Tenodesis versus carbon fiber repair of ankle ligaments: a clinical comparison. Clin Orthop Relat Res 325:194–202

    Article  PubMed  Google Scholar 

  3. Bell SJ, Mologne TS, Sitler DF, Cox JS (2006) Twenty-six-year results after Broström procedure for chronic lateral ankle instability. Am J Sports Med 34(6):975–978

    Article  PubMed  Google Scholar 

  4. Broström L (1966) Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir Scand 132(5):551–565

    PubMed  Google Scholar 

  5. Burks RT, Morgan J (1994) Anatomy of the lateral ankle ligaments. Am J Sports Med 22(1):72–77

    Article  PubMed  CAS  Google Scholar 

  6. Caprio A, Oliva F, Treia F, Maffulli N (2006) Reconstruction of the lateral ankle ligaments with allograft in patients with chronic ankle instability. Foot Ankle Clin 11(3):597–605

    Article  PubMed  Google Scholar 

  7. Chrisman OD, Snook GA (1969) 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 51(5):904–912

    PubMed  CAS  Google Scholar 

  8. Colville MR (1998) Surgical treatment of the unstable ankle. J Am Acad Orthop Surg 6(6):368–377

    PubMed  CAS  Google Scholar 

  9. Colville MR, Marder RA, Zarins B (1992) Reconstruction of the lateral ankle ligaments. A biomechanical analysis. Am J Sports Med 20(5):594–600

    Article  PubMed  CAS  Google Scholar 

  10. Coughlin MJ, Schenck RC Jr, Grebing BR, Treme G (2004) Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft. Foot Ankle Int 25(4):231–241

    PubMed  Google Scholar 

  11. Elmslie RC (1934) Recurrent subluxation of the ankle-joint. Ann Surg 100(2):364–367

    Article  PubMed  CAS  Google Scholar 

  12. Evans DL (1953) Recurrent instability of the ankle; a method of surgical treatment. Proc R Soc Med 46(5):343–344

    PubMed  CAS  Google Scholar 

  13. Girard P, Anderson RB, Davis WH, Isear JA, Kiebzak GM (1999) Clinical evaluation of the modified Broström-Evans procedure to restore ankle stability. Foot Ankle Int 20(4):246–252

    PubMed  CAS  Google Scholar 

  14. Gould N (1987) Repair of lateral ligament of ankle. Foot Ankle 8(1):55–58

    PubMed  CAS  Google Scholar 

  15. Gould N, Seligson D, Gassman J (1980) Early and late repair of lateral ligament of the ankle. Foot Ankle 1(2):84–89

    PubMed  CAS  Google Scholar 

  16. Hamilton WG, Thompson FM, Snow SW (1993) The modified Broström procedure for lateral ankle instability. Foot Ankle 14(1):1–7

    PubMed  CAS  Google Scholar 

  17. Horibe S, Shino K, Taga I, Inoue M, Ono K (1991) Reconstruction of lateral ligaments of the ankle with allogeneic tendon grafts. J Bone Joint Surg Br 73(5):802–805

    PubMed  CAS  Google Scholar 

  18. Jeys L, Korrosis S, Stewart T, Harris NJ (2004) Bone anchors or interference screws? A biomechanical evaluation for autograft ankle stabilization. Am J Sports Med 32(7):1651–1659

    Article  PubMed  Google Scholar 

  19. Karlsson J, Bergsten T, Lansinger O, Peterson L (1988) Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am 70(4):581–588

    PubMed  CAS  Google Scholar 

  20. Karlsson J, Bergsten T, Lansinger O, Peterson L (1989) Surgical treatment of chronic lateral instability of the ankle joint. A new procedure. Am J Sports Med 17(2):268–273 (discussion 273–274)

    Article  PubMed  CAS  Google Scholar 

  21. Karlsson J, Eriksson BI, Bergsten T, Rudholm O, Sward L (1997) Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint. Am J Sports Med 25(1):48–53

    Article  PubMed  CAS  Google Scholar 

  22. Kjaersgaard-Andersen P, Madsen F, Frich LH, Wethelund JO, Sojbjerg JO (1990) Lateral hindfoot instability treated with the Evans tenodesis: a biomechanical analysis. J Foot Surg 29(1):25–32

    PubMed  CAS  Google Scholar 

  23. Kjaersgaard-Andersen P, Sojbjerg JO, Wethelund JO, Helmig P, Madsen F (1989) Watson-Jones tenodesis for ankle instability. A mechanical analysis in amputation specimens. Acta Orthop Scand 60(4):477–480

    Article  PubMed  CAS  Google Scholar 

  24. Krips R, van Dijk CN, Halasi PT, Lehtonen H, Corradini C, Moyen B, Karlsson J (2001) 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 22(5):415–421

    PubMed  CAS  Google Scholar 

  25. Marrale J, Morrissey MC, Haddad FS (2007) A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15(6):690–704

    Article  PubMed  Google Scholar 

  26. Paterson R, Cohen B, Taylor D, Bourne A, Black J (2000) Reconstruction of the lateral ligaments of the ankle using semi-tendinosis graft. Foot Ankle Int 21(5):413–419

    PubMed  CAS  Google Scholar 

  27. Rosenbaum D, Bertsch C, Claes LE (1997) NOVEL Award 1996: 2nd prize tenodeses do not fully restore ankle joint loading characteristics: a biomechanical in vitro investigation in the hind foot. Clin Biomech (Bristol, Avon) 12(3):202–209

    Article  Google Scholar 

  28. Sammarco VJ (2001) Complications of lateral ankle ligament reconstruction. Clin Orthop Relat Res 391:123–132

    Article  PubMed  Google Scholar 

  29. Snook GA, Chrisman OD, Wilson TC (1985) Long-term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle. J Bone Joint Surg Am 67(1):1–7

    PubMed  CAS  Google Scholar 

  30. Sugimoto K, Takakura Y, Kumai T, Iwai M, Tanaka Y (2002) Reconstruction of the lateral ankle ligaments with bone-patellar tendon graft in patients with chronic ankle instability: a preliminary report. Am J Sports Med 30(3):340–346

    PubMed  Google Scholar 

  31. Watson-Jones R (1955) Fractures and joint injuries, vol II, 4th edn. E & S Livingstone Ltd, Edinburgh

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, Korea

    Hong-Geun Jung, Tae-Hoon Kim & Eui-Jung Bae

  2. Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea

    Jae-Yong Park

Authors
  1. Hong-Geun Jung
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  2. Tae-Hoon Kim
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  3. Jae-Yong Park
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  4. Eui-Jung Bae
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Correspondence to Hong-Geun Jung.

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Jung, HG., Kim, TH., Park, JY. et al. Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments using a semitendinosus tendon allograft and interference screws. Knee Surg Sports Traumatol Arthrosc 20, 1432–1437 (2012). https://doi.org/10.1007/s00167-011-1666-y

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