Anatomical Repair for Chronic Lateral Ankle Instability

Hyung Jin Chung

doi:10.4055/jkoa.2014.49.1.13

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Chung: Anatomical Repair for Chronic Lateral Ankle Instability

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Ankle Sprain: Current Trends

Journal of the Korean Orthopaedic Association 2014; 49(1): 13-21.

Published online: 27 February 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.1.13

Anatomical Repair for Chronic Lateral Ankle Instability

Hyung Jin Chung, M.D.

Department of Orthopaedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Correspondence to: Hyung Jin Chung, M.D. Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea. TEL: +82-2-950-1399, FAX: +82-2-950-1398, chunghj@dreamwiz.com

Received 30 September 2013 Revised 27 December 2013 Accepted 4 February 2014

(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

Ankle sprain secondarily leads to chronic lateral ankle instability in 20%-30% of cases. Many surgical procedures have been presented for lateral ankle instability; however, controversy remains regarding the ideal surgical option. The Bröstrom procedure or its modifications have been widely used; however, they have some limitations for the instabilities of over-weight, physically high demanding patients, generalized ligamentous laxity, and especially for significantly deficient or attenuated ligaments. This article reports on the difference between the bone tunnel technique and the suture anchor technique of the modified Bröstrom procedure, and also provides a review of several recent debates.

Keywords: ankle, chronic lateral instability, anatomical repair

Figures and Tables

Figure 1

The anterior drawer test. (A) Physical examination. (B) Telos in visual. (C) Telos in radiograph. (D) Measurement of anterior-posterior distance (arrows).

Figure 2

The talar tilt test. (A) Physical examination. (B) Telos in visual. (C) Telos in radiograph. (D) Measurement of angle of varus instability.

Figure 3

(A) Bröstrom (1966), (B) Gould (1980), (C) Karlson (1988) procedure.

Figure 4

(A) Four drill holes were made at the anteriorinferior portion of the lateral malleolus. (B) The ATFL, CFL, and joint capsule were fixed on the fibula using nonabsorbable suture material. (C) The ER was reinforced to the periosteum of the distal fibula. CFL, calcaneofibular ligament; ATFL, anterior talofibular ligament; ER, extensor retinaculum. Reproduced from Hu et al. Am J Sports Med. 2013;41:1880. with permission of the copyright holder.14)

Figure 5

(A) Stirrup brace. (B) Aircast.

Figure 6

(A) A SA was inserted into the center of the anatomic footprint of the ATFL and calcaneofibular ligament. (B) Rigid fixation using a 4-stranded suture technique was performed. (C) The ER was advanced to the periosteum of the distal fibula. SA, single suture anchor; ATFL, anterior talofibular ligament; ER, extensor retinaculum. Reproduced from Hu et al. Am J Sports Med. 2013;41:1880. with permission of the copyright holder.14)

Figure 7

We have to repair the anterior talofibular ligament to cover the filling defect of the anterior talofibular ligament (ATFL) attachment area on the fibular (D). (A) Normal. (B) Loose and thin ATFL. (C) Routine Bröstrom repair. (D) Attached inner side.

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