SLR - July 2015 - Walker L. Estes

Ankle Lateral Ligament Reconstruction for Chronic Instability

Reference: Yong R, Weng Lei K, Hock Ooi L. Ankle lateral ligament reconstruction for chronic instability. Journal of Orthopedic Surgery. 2015 April; 23(1): 62-5.

Scientific Literature Review

Reviewed By: Walker L. Estes, DPM
Residency Program: Detroit Medical Center

Podiatric Relevance:  Lateral ankle ligament injury is a common problem. It has a 7 per 1000 person per year incidence. Many patients experience instability initially and approximately half of those patients have instability one year after non-operative treatment. 30-40% of patients develop persistent instability requiring reconstruction. There are many different ways to reconstruct the lateral ankle ligaments. This article reports on a technique that combines an anatomic repair with an augmented repair.

Methods:  Twenty-four patients (13 male and 2 female) with recurrent inversion ankle injuries who failed rehabilitation and use of ankle braces underwent lateral ankle reconstruction by a single surgeon. All patients had positive anterior drawer signs, heel eversion stress test and tenderness over anterolateral joint capsule. A 5-7 cm peroneus brevis autograft was taken and rerouted through a 4.5mm diameter, 5cm long osseous tunnel in the fibula to recreate the ATFL. A 5.5 x 15 mm biotenodesis screw was inserted into the tunnel to fix the graft. Patients were immobilized for 1 week in a case followed by full weight bearing with a walking boot at week 2. After 6 weeks ankle, subtalar and proprioceptive training were started. After 3 months return to sports with ankle braces was allowed for another 6 months.

Results:  The mean time from injury to surgery was 40.5 months. The mean follow up was 13.6 months. The mean AOFAS ankle and hindfoot score was 91.5. The mean FAOS was 78.8. 10 patients had no limitation in daily or recreational activities; 3 had limitation in recreational activities, and 2 had limitation in both. 12 patients had normal hindfoot motion and 3 had moderate limitation. One patient developed hindfoot instability.
Conclusions:  Chronic ankle instability is a common problem especially in adults who participate in recreational sporting activities. 30-40 percent of patients develop chronic ankle instability following injury and conservative treatment.  There are several options for surgical reconstruction. This article suggests that a combination of augmented and direct anatomic reconstruction enables early mobilization despite limitation in hindfoot motion and is a viable option for chronic hindfoot instability.

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