Anatomic Reconstruction of the Lateral Ankle Instability Using the Semitendinosus Allograft Tendon and Interference Screws

Hong-Geun Jung; Jae-Yong Park; Eui-Jung Bae; Tae-Hoon Kim

doi:10.4055/jkoa.2011.46.1.10

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Jung, Park, Bae, and Kim: Anatomic Reconstruction of the Lateral Ankle Instability Using the Semitendinosus Allograft Tendon and Interference Screws

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(1): 10-17.

Published online: 22 February 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.1.10

Anatomic Reconstruction of the Lateral Ankle Instability Using the Semitendinosus Allograft Tendon and Interference Screws

Hong-Geun Jung, M.D., Ph.D., Jae-Yong Park, M.D., Eui-Jung Bae, M.D., Tae-Hoon Kim, M.D.

Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Korea.

Correspondence to: Hong-Geun Jung, M.D., Ph.D. Department of Orthopaedic Surgery, Konkuk University Medical Center, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea. TEL: +82-2-2030-7609, FAX: +82-2-2030-7369, jungfoot@hanmail.net

Received 29 December 2009 Accepted 16 August 2010

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Purpose

To evaluate the clinical outcome of the anatomic reconstruction of the lateral ankle instability using the semitendinosus allograft tendon and the interference screws.

Materials and Methods

This study is based on the 12 feet of lateral ankle instability that had been treated with anatomic reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) using the semitendinosus allograft tendon and the interference screws. The majority of patients were young and physically active. We evaluated the patients' VAS pain scores, AOFAS scores and Karlsson-Peterson ankle scores for the 11 feet involved with at least 12 months follow up, both pre- and post-operative. In addition, we evaluated patient satisfaction. We measured the talar tilt angles and the talar anterior translations from ankle stress views.

Results

The average age at surgery was 25.9 years old (19-57 years); patients had symptoms of recurrent sprain for average 31.4 months before surgery. The average follow up period was 14 months. For reconstruction, we used 4.0mm thick allograft semitendinosus tendon and interference screws. VAS pain scores decreased from 6.0 to 1.1 (p<0.05) and AOFAS scores improved from 70.4 to 90.4 postoperatively (p<0.05). Karlsson-Peterson ankle scores improved significantly from 54.6 to 92.4 (p<0.05). Radiographic talar tilt decreased from 15.7° to 3.2° postoperatively (p<0.05). Eighy-two percent of the patients were satisfied with the results and the patients had returned to their jobs by 3.7 months after surgery.

Conclusion

Anatomic reconstruction of the ATFL and the CFL in the lateral ankle instability patients using the semitendinosus tendon and the interference screws is an ideal surgical option especially for young athletes with high grade instabilities.

Keywords: lateral ankle instability, anatomic reconstruction, semitendinosus tendon, interference screw

Figures and Tables

Figure 1

The semitendinosus allograft tendon was fixed with an interference screw at ATFL insertion site of anterior margin of lateral talar body.

Figure 2

Two fibular tunnels were made at ATFL and CFL attachment sites of distal fibula.

Figure 3

Schematic diagram of ATFL and CFL anatomic reconstruction with the semitendinosus allograft tendon and interference screws.

Figure 4

Varus stress radiograph of patient #6. Preoperative talar tilt of 17° (A) decreased to 3° at postoperative 18 months (B).

Table 1

Summary of Lateral Ankle Instability Patients

No, number; M/F, male/female; LAI, lateral ankle instability; Rt/Lt, right/left; AOFAS, American Orthopaedic Foot and Ankle Society ankle-hindfoot functional scale; Preop, preoperative; VAS, visual analogue pain scale; OLT, osteochondral lesion of talus.

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