SLR - May 2016 - Timothy P. McConn

Title: Activity Level and Function After Lateral Ankle Ligament Repair Versus Reconstruction

Reference: Matheny LM, Johnson NS, Liechti DJ, Clanton TO. Activity Level and Function After Lateral Ankle Ligament Repair Versus Reconstruction. Am J Sports Med. 2016 Feb 26.

Scientific Literature Review

Reviewed by: Timothy P. McConn, DPM
Residency Program: West Penn

Podiatric Relevance: Ankle sprains are one of the most common musculoskeletal injuries treated by foot and ankle surgeons consisting of 23,000 ankle injuries per day and 2 million sprains per year in the U.S. Eighty percent of these acute injuries will resolve with conservative treatment; however, 20 percent will go onto chronic lateral ankle instability requiring surgical intervention. Broström originally described a direct anatomic repair of the native ATFL, which was followed by Gould describing a modification incorporating the inferior extensor retinaculum. This has been considered the gold standard, yet in select cases reconstruction with allograft requiring bone tunnels and tenodesis screw fixation is required. This study attempts to compare the outcomes of the two described procedures.

Methods: From September 2009 to February 2013 all patients undergoing Broström-Gould repair or lateral ankle allograft reconstruction by a single surgeon were included in the study.  Patients excluded were those <18 y/o and those with previous tibiotalar arthrodesis or arthroplasty. Multiple outcome measures were used including FADI, AOFAS, WOMAC, SF-12, PCS, MCS, and VAS. All patients underwent the same post-op protocol including posterior splint for 7-10 days followed by protective WB in walking boot with strict physical therapy regimens. At six weeks, gait training out of the walking boot was began. At 8-10 weeks, the walking boot was discontinued and activity was permitted as tolerated.

Results: Eighty-six patients (45 males, 41 females) with a mean age of 38 and mean BMI of 26.5 met the inclusion criteria. Sixty-one were in the repair cohort and 25 in the reconstruction cohort. There was 84 percent (21/25) follow-up for the repair cohort and 90 percent (55/61) follow-up for the reconstruction cohort. No patient in either cohort required revision surgery; however, seven of the repair cohort and four of the reconstruction cohort required subsequent surgery not related to the lateral ankle repair or reconstruction. Overall, there was no significant difference in any outcome scores between the two cohorts. There were also no differences in terms of functional outcomes as well as for general health scores. No significant difference was noted with patient satisfaction scores either.

Conclusions: In the current study, patients who underwent surgical treatment of lateral ankle ligaments, by repair or reconstruction, had similar postoperative function and activity levels at a minimum follow-up of two years. Both cohorts did not have any patients who underwent revision lateral ligament surgery. While traditionally the Broström-Gould has been known as the gold standard, results suggest that anatomic reconstruction with allograft is a good option in cases where the Broström-Gould repair is not possible or is deemed likely to fail. Chronic ankle instability and pain have been documented as indications for allograft reconstruction, which has gained popularity in recent years.

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