The Indication of Ankle Lateral Ligament Reconstruction Using Tendon Graft in Chronic Ankle Instability

Jae Yong Park; Gi-Won Choi; Jae-ho Cho; Chan Kang; Kyungjin Choi; Jin-Wha Chung; Hak Jun Kim; Su-Young Bae; Seung-Do Cha; Ki Chun Kim; Seung Hwan Han

doi:10.14193/jkfas.2016.20.1.12

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Park, Choi, Cho, Kang, Choi, Chung, Kim, Bae, Cha, Kim, and Han: The Indication of Ankle Lateral Ligament Reconstruction Using Tendon Graft in Chronic Ankle Instability

Original Article

J Korean Foot Ankle Soc 2016;20(1):12-18.

Published online: 10 March 2016

DOI: https://doi.org/10.14193/jkfas.2016.20.1.12

The Indication of Ankle Lateral Ligament Reconstruction Using Tendon Graft in Chronic Ankle Instability

Jae Yong Park, Gi-Won Choi^*, Jae-ho Cho^†, Chan Kang^‡, Kyungjin Choi^§, Jin-Wha Chung^∥, Hak Jun Kim, Su-Young Bae^**, Seung-Do Cha^††, Ki Chun Kim^‡‡, Seung Hwan Han^§§

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

^*Department of Ansan Hospital, Korea University College of Medicine, Ansan, Daejeon, Korea

^{^†}Department of Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Daejeon, Korea

^‡Department of Chungnam National University Hospital, Daejeon, Korea

^§Dr. Choi's Orthopedics, Seoul, Korea

^∥The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Guro Hospital, Korea University College of Medicine, Seoul, Korea

^**Inje University Sanggye Paik Hospital, Seoul, Korea

^††Saeum Hospital, Seoul, Korea

^‡‡Seoul Medical Center, Seoul, Korea

^§§Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Corresponding Author: Seung Hwan Han Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul 06273, Korea Tel: 82-2-2019-3410, Fax: 82-2-573-5395, E-mail: osmedic@yuhs.ac

Received 23 February 2016 Revised 1 March 2016 Accepted 1 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to review the indications of ankle lateral complex reconstruction using tendon graft.

Materials and Methods

We searched PubMed using the index, “ankle, instability, lateral ligament, reconstruction” from 1990 to present (September 30, 2015). We excluded 1) modified Brőstrom operation (MBO), 2) conventional tenodesis surgery, 3) review article, 4) technical note, and 5) articles written in another foreign language. We reviewed 24 papers through the publication events, operational method, the indications of surgery, and the specific features of the patient group.

Results

There were the indications of 1) previous ligament surgery failure, 2) situation when ligament repair is impossible due to the ligament defect, 3) severe instability (preoperative talar tilt >15°, anterior draw >10 mm or the difference of contralateral side talar tilt >5°, anterior draw >3 mm), and 4) overweight (body mass index >30 kg/m²). Other considerations included 1) generalized joint laxity and 2) workers, highly-demanded or athlete highly-affected by instability.

Conclusion

The ankle lateral complex reconstruction using tendon graft could be indicated in patients with the possibility of MBO failure with several considerations.

Keywords: Ankle, Chronic joint instability, Ligament reconstruction, Indications

References

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Table 1.

Characteristics of the Article Included in Our Review

Reference No.	Year	Name of journal^*	Nation	Corresponding author	Case enroll	No. of ankles (patients)	No. of f/u ankles (patients)	Mean f/u period	Mean age (yr)	Used tendon	Fixation method	Recontruction object	Remarks
3)	2015	Foot Ankle Int.	Korea	Sang-Hun Lee	2007. 2∼2013. 1	72 (70)	66 (64)	22.1 mo (12∼68 mo)	30.3 (16∼59)	Allo	Screw	ATFL & CFL
4)	2015	Am J Sports Med.	USA	Richard D. Ferkel	2003∼2011	40 (38)	33 (31)	38 mo (24∼107 mo)	28.3 (16∼74)	Allo	Screw	ATFL & CFL
5)	2015	Knee Surg Sports Traumatol Arthrosc.	Korea	Yong Wook Park	2008∼2011	36 (34)	31 (29)	21 mo (12∼51 mo)	24 (19∼46)	Auto	Screw	ATFL & CFL
6)	2014	Foot Ankle Int.	China	Xiangyang Xu	2006. 9∼2011. 6	Auto: 32 Allo: 36	Auto: 23 Allo: 26	Auto: 33.5±6.7 mo Allo: 28.5±6.7 mo	Auto: 32.4±2.4 Allo: 33.2±3.2	Auto	Screw	ATFL & CFL	Auto vs allo
7)	2014	Muscles Ligaments Tendons J.	Italy	Gherardo Pagliazzi	–	38	38	5 yr (2∼8 yr)	25.9±7.4	Auto & allo	Screw or suture anchor	ATFL & CFL (6), ATFL (15)	MBO vs reconstruction
8)	2014	Am J Sports Med.	Japan	Wataru Miyamoto	2007. 1∼2010. 3	69	33	2 yr	27.7 (18∼43), immobilization group 26.4 (21∼40), early rehabilitation group	Auto	Screw	ATFL	Immobilization vs early rehabilitation
9)	2013	Foot Ankle Int.	USA	Steven M. Raikin	2005∼2011	28	28	32 mo (12∼79 mo)	47.7 (16∼69)	Allo	Screw	ATFL & CFL
10)	2013	Foot Ankle Int.	China	Xiang-Yang Xu	2006. 9∼2010. 5	25	25	32.3 mo (12∼56 mo)	32.4 (17∼62)	Auto	Screw	ATFL & CFL
11)	2012	Int Orthop.	China	Yinghui Hua	2007. 4∼2009. 9	37 (36)	36 (35)	37.9 mo (24∼54 mo)	29.2 (18∼52)	Allo	Screw & suture	ATFL & CFL
12)	2012	Am J Sports Med.	USA	John G. Kennedy	–	57	57	32 mo (12∼47 mo)	28 (17∼65)	Auto	Screw	ATFL
13)	2012	Knee Surg Sports Traumatol Arthrosc.	Korea	Hong-Geun Jung	2007∼2009	28 (27)	24	19 mo (12∼26 mo), median	36.5 (16∼57), median	Allo	Screw	ATFL & CFL
14)	2012	Foot Ankle Int.	Korea	Jin Woo Lee	2006. 10∼2009. 4	15 (13)	15 (13)	17.3 mo (12∼34 mo)	29 (21∼53)	Allo	Screw	ATFL & CFL
15)	2011	Foot Ankle Surg.	Kuwait	t S. A. Ibrahim	2004. 1∼2008. 2	16	14	33.5 mo (32∼48 mo)	25 (18∼29)	Auto	Screw	ATFL & CFL
16)	2011	HSS J.	USA	Scott J. Ellis	2004. 2∼2008. 1	12 (11)	12 (11)	3.5 yr (1.2∼5.0 yr)	48.9±11.4	Allo	Screw	ATFL & CFL
17)	2011	Am J Sports Med.	Korea	Jae Hoon Ahn	2003. 7∼2007. 12	24	24	37 mo (24∼56 mo)	35.7 (16∼53)	Auto	Screw	ATFL & CFL (21), ATFL (3)
18)	2005	Am J Sports Med.	Japan	Masato Takao	2001. 4∼2002. 5	25	21	Minimum 2 yr	29.6 (16∼42)	Auto	Screw	ATFL & CFL (4), ATFL (17)
19)	2004	Foot Ankle Int.	USA	Michael J. Coughlin	1998. 12∼2002. 2	29 (28)	29 (28)	23 mo (12∼52 mo)	31 (16∼59)	Auto	Suture	ATFL & CFL
20)	2003	Arch Orthop Trauma Surg.	Japan	Toshiaki Takahashi	1989∼	23	13	7.2 yr (5∼10 yr)	35.4 (13∼51)	Auto	Suture	ATFL & CFL (6), ATFL (7)
21)	2002	Am J Sports Med.	Japan	Kazuya Sugimoto	1996. 1∼2000. 10	45	13	26.5 mo (12∼60 mo)	39.1 (21∼56)	Auto	Suture anchor	ATFL & CFL
22)	2000	J Bone Joint Surg Br.	Japan	Konsei Shino	–	22	20	4.2 yr (3.1∼10 yr)	20.2 (15∼31)	Allo	Suture	ATFL & CFL (13), ATFL (7)
23)	2000	Foot Ankle Int.	Australia	R. S. Paterson	1986∼1992	28	26	24 mo (13∼46 mo)	24 (18∼36)	Auto	Suture	ATFL
24)	1999	Foot Ankle Int.	Japan	Ryuzo Okuda	1989∼1994	28 (27)	27 (26)	37 mo (24∼57 mo)	24 (13∼56)	Auto	Suture	ATFL & CFL (16), ATFL (11)
25)	1991	J Bone Joint Surg Br.	Japan	Konsei shino	–	17	13	3.1 yr (2∼5.2 yr)	23 (15∼39)	Allo	Button	ATFL & CFL (3), ATFL (10)
26)	1991	J Foot Surg.	USA	Steven J. Palladino	–	8	8	12.7 mo (3.5∼27 mo)	) 35 (16∼76)	Auto	Screw & suture	ATFL & CFL

Auto: autograft, Allo: allograft, f/u: follow-up, ATFL: anterior talofibular ligament, CFL: calcaneofibula ligament, MBO: modified Brő strom operation.

^* Names are presented as abbreviation of journal name.

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