Journal List > J Korean Foot Ankle Soc > v.23(1) > 1127161

Kim and Park: Surgical Treatment of Chronic Lateral Ankle Instability: Repair versus Reconstruction

Abstract

Surgical treatment to restore stability in the ankle and hindfoot and prevent further degenerative changes may be necessary in cases in which conservative treatment has failed. Anatomical direct repair using native ligament remnants with or without reinforcement of the inferior retinaculum is the so-called gold standard operative strategy for the treatment of lateral ankle instability. Non-anatomical lateral ligament reconstruction typically involves the use of the adjacent peroneus brevis tendon and applies only those with poor-quality ligaments. On the other hand, anatomic reconstruction and anatomic repair provide better functional outcomes after the surgical treatment of chronic ankle instability patients compared to a non-anatomic reconstruction. Anatomical reconstruction using an autograft or allograft applies to patients with insufficient ligament remnants to fashion direct repair, failed previous lateral ankle repair, high body mass index, or generalized ligamentous laxity. These procedures can provide good-to-excellent short-term outcomes. Arthroscopic ligament repair is becoming increasingly popular because it is minimally invasive. Good-to-excellent clinical outcomes have been reported after short and long-term follow-up, despite the relatively large number of complications, including nerve damage, reported following the procedure. Therefore, further investigation will be needed before widespread adoption is advocated.

Figures and Tables

Figure 1

Non-anatomic reconstruction of lateral ligaments. (A) Watson-Jones procedure. (B) Evans procedure. (C) Chrisman-Snook procedure.

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Figure 2

Various kinds of anatomical reconstruction of lateral ligaments. Two hole techniques (A, B) and one hole technique (C).

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Notes

The point of this article was presented by the 62nd Spring Congress of the Korean Orthopaedic Association.

Financial support None.

Conflict of interest None.

References

1. Sammarco VJ. Complications of lateral ankle ligament reconstruction. Clin Orthop Relat Res. 2001; (391):123–132.
crossref
2. Valderrabano V, Hintermann B, Horisberger M, Fung TS. Ligamentous posttraumatic ankle osteoarthritis. Am J Sports Med. 2006; 34:612–620.
crossref
3. Kim DW, Sung KS. Chronic lateral ankle instability. J Korean Foot Ankle Soc. 2018; 22:55–61.
crossref
4. Gould N, Seligson D, Gassman J. Early and late repair of lateral ligament of the ankle. Foot Ankle. 1980; 1:84–89.
crossref
5. Bell SJ, Mologne TS, Sitler DF, Cox JS. Twenty-six-year results after Broström procedure for chronic lateral ankle instability. Am J Sports Med. 2006; 34:975–978.
crossref
6. Lee KT, Park YU, Kim JS, Kim JB, Kim KC, Kang SK. Long-term results after modified Brostrom procedure without calcaneofibular ligament reconstruction. Foot Ankle Int. 2011; 32:153–157.
crossref
7. Tourné Y, Mabit C, Moroney PJ, Chaussard C, Saragaglia D. Long-term follow-up of lateral reconstruction with extensor retinaculum flap for chronic ankle instability. Foot Ankle Int. 2012; 33:1079–1086.
crossref
8. Karlsson J, Bergsten T, Lansinger O, Peterson L. Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am. 1988; 70:581–588.
crossref
9. Paden MH, Stone PA, McGarry JJ. Modified Brostrom lateral ankle stabilization utilizing an implantable anchoring system. J Foot Ankle Surg. 1994; 33:617–622.
10. Cho BK, Kim YM, Kim DS, Choi ES, Shon HC, Park KJ. Outcomes of the modified Brostrom procedure using suture anchors for chronic lateral ankle instability--a prospective, randomized comparison between single and double suture anchors. J Foot Ankle Surg. 2013; 52:9–15.
crossref
11. Lee KT, Lee JI, Sung KS, Kim JY, Kim ES, Lee SH, et al. Biomechanical evaluation against calcaneofibular ligament repair in the Brostrom procedure: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2008; 16:781–786.
crossref
12. Jeong BO, Kim MS, Song WJ, SooHoo NF. Feasibility and outcome of inferior extensor retinaculum reinforcement in modified Broström procedures. Foot Ankle Int. 2014; 35:1137–1142.
crossref
13. So E, Preston N, Holmes T. Intermediate- to long-term longevity and incidence of revision of the modified Broström-gould procedure for lateral ankle ligament repair: a systematic review. J Foot Ankle Surg. 2017; 56:1076–1080.
crossref
14. Kang HJ, Jung HG. Indications of lateral ankle ligament reconstruction with a free tendon and associated evidence. J Korean Foot Ankle Soc. 2018; 22:91–94.
crossref
15. Gillespie HS, Boucher P. Watson-Jones repair of lateral instability of the ankle. J Bone Joint Surg Am. 1971; 53:920–924.
crossref
16. Evans DL. Recurrent instability of the ankle; a method of surgical treatment. Proc R Soc Med. 1953; 46:343–344.
17. Colville MR, Marder RA, Zarins B. Reconstruction of the lateral ankle ligaments. A biomechanical analysis. Am J Sports Med. 1992; 20:594–600.
18. Chrisman OD, Snook GA. Reconstruction of lateral ligament tears of the ankle. An experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure. J Bone Joint Surg Am. 1969; 51:904–912.
19. Hedeboe J, Johannsen A. Recurrent instability of the ankle joint. Surgical repair by the Watson-Jones method. Acta Orthop Scand. 1979; 50:337–340.
crossref
20. El Tohamy WA, El Mahboub N. The results of surgical treatment of chronic lateral ankle instability with the Evans technique. Egypt Orthop J. 2016; 51:54–59.
crossref
21. Cheng M, Tho KS. Chrisman-Snook ankle ligament reconstruction outcomes--a local experience. Singapore Med J. 2002; 43:605–609.
22. Sugimoto K, Takakura Y, Akiyama K, Kamei S, Kitada C, Kumai T. Long-term results of Watson-Jones tenodesis of the ankle. Clinical and radiographic findings after ten to eighteen years of follow-up. J Bone Joint Surg Am. 1998; 80:1587–1596.
crossref
23. Korkala O, Sorvali T, Niskanen R, Haapala J, Tanskanen P, Kuokkanen H. Twenty-year results of the Evans operation for lateral instability of the ankle. Clin Orthop Relat Res. 2002; (405):195–198.
crossref
24. Snook GA, Chrisman OD, Wilson TC. Long-term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle. J Bone Joint Surg Am. 1985; 67:1–7.
crossref
25. van der Rijt AJ, Evans GA. The long-term results of Watson-Jones tenodesis. J Bone Joint Surg Br. 1984; 66:371–375.
crossref
26. Karlsson J, Bergsten T, Lansinger O, Peterson L. Lateral instability of the ankle treated by the Evans procedure. A long-term clinical and radiological follow-up. J Bone Joint Surg Br. 1988; 70:476–480.
crossref
27. Jung HG, Park JY, Park JT. Chronic lateral ankle instability. J Korean Foot Ankle Soc. 2012; 16:73–78.
28. Ellis SJ, Williams BR, Pavlov H, Deland J. Results of anatomic lateral ankle ligament reconstruction with tendon allograft. HSS J. 2011; 7:134–140.
crossref
29. Jung HG, Kim TH, Park JY, Bae EJ. Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments using a semitendinosus tendon allograft and interference screws. Knee Surg Sports Traumatol Arthrosc. 2012; 20:1432–1437.
crossref
30. Kim HN, Jeon JY, Dong Q, Noh KC, Chung KJ, Kim HK, et al. Lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon. Knee Surg Sports Traumatol Arthrosc. 2015; 23:1877–1885.
crossref
31. Takahashi T, Nakahira M, Kaho K, Kawakami T. Anatomical reconstruction of chronic lateral ligament injury of the ankle using pedicle tendon of the extensor digitorum longus. Arch Orthop Trauma Surg. 2003; 123:175–179.
crossref
32. Kennedy JG, Smyth NA, Fansa AM, Murawski CD. Anatomic lateral ligament reconstruction in the ankle: a hybrid technique in the athletic population. Am J Sports Med. 2012; 40:2309–2317.
crossref
33. Coughlin MJ, Schenck RC Jr, Grebing BR, Treme G. Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft. Foot Ankle Int. 2004; 25:231–241.
crossref
34. Sugimoto K, Takakura Y, Kumai T, Iwai M, Tanaka Y. Reconstruction of the lateral ankle ligaments with bone-patellar tendon graft in patients with chronic ankle instability: a preliminary report. Am J Sports Med. 2002; 30:340–346.
crossref
35. Takao M, Oae K, Uchio Y, Ochi M, Yamamoto H. Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft: a new technique using an interference fit anchoring system. Am J Sports Med. 2005; 33:814–823.
crossref
36. Caprio A, Oliva F, Treia F, Maffulli N. Reconstruction of the lateral ankle ligaments with allograft in patients with chronic ankle instability. Foot Ankle Clin. 2006; 11:597–605.
crossref
37. Vuurberg G, Pereira H, Blankevoort L, van Dijk CN. Anatomic stabilization techniques provide superior results in terms of functional outcome in patients suffering from chronic ankle instability compared to non-anatomic techniques. Knee Surg Sports Traumatol Arthrosc. 2018; 26:2183–2195.
crossref
38. DiGiovanni BF, Partal G, Baumhauer JF. Acute ankle injury and chronic lateral instability in the athlete. Clin Sports Med. 2004; 23:1–19. v
crossref
39. Maffulli N, Del Buono A, Maffulli GD, Oliva F, Testa V, Capasso G, et al. Isolated anterior talofibular ligament Broström repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med. 2013; 41:858–864.
crossref
40. Maffulli N, Ferran NA. Management of acute and chronic ankle instability. J Am Acad Orthop Surg. 2008; 16:608–615.
crossref
41. Komenda GA, Ferkel RD. Arthroscopic findings associated with the unstable ankle. Foot Ankle Int. 1999; 20:708–713.
crossref
42. Kashuk KB, Carbonell JA, Blum JA. Arthroscopic stabilization of the ankle. Clin Podiatr Med Surg. 1997; 14:459–478.
43. Corte-Real NM, Moreira RM. Arthroscopic repair of chronic lateral ankle instability. Foot Ankle Int. 2009; 30:213–217.
crossref
44. Wang J, Hua Y, Chen S, Li H, Zhang J, Li Y. Arthroscopic repair of lateral ankle ligament complex by suture anchor. Arthroscopy. 2014; 30:766–773.
crossref
45. Giza E, Shin EC, Wong SE, Acevedo JI, Mangone PG, Olson K, et al. Arthroscopic suture anchor repair of the lateral ligament ankle complex: a cadaveric study. Am J Sports Med. 2013; 41:2567–2572.
crossref
46. Lee KT, Kim ES, Kim YH, Ryu JS, Rhyu IJ, Lee YK. All-inside arthroscopic modified Broström operation for chronic ankle instability: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2016; 24:1096–1100.
crossref
47. Drakos MC, Behrens SB, Paller D, Murphy C, DiGiovanni CW. Biomechanical comparison of an open vs arthroscopic approach for lateral ankle instability. Foot Ankle Int. 2014; 35:809–815.
crossref
48. Yeo ED, Lee KT, Sung IH, Lee SG, Lee YK. Comparison of all-inside arthroscopic and open techniques for the modified Broström procedure for ankle instability. Foot Ankle Int. 2016; 37:1037–1045.
crossref
49. Li H, Hua Y, Li H, Ma K, Li S, Chen S. Activity level and function 2 years after anterior talofibular ligament repair: a comparison between arthroscopic repair and open repair procedures. Am J Sports Med. 2017; 45:2044–2051.
crossref
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Young Uk Park
https://orcid.org/0000-0002-3400-497X

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