Allograft tendon reconstruction of the anterior talofibular ligament and calcaneofibular Ligament in the treatment of chronic ankle instability

Abstract

BackgroundThe purpose was retrospectively to investigate functional and clinical outcomes after anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) reconstruction using a single allograft.MethodsPatients with severe chronic lateral instability of the ankle underwent surgery after conservative treatment failed. Ultrasounds of the ankle were performed, and if the AFTL and CFL were completely torn without enough soft tissue for repair, the ligaments were reconstructed using allograft tendon. Outcomes were assessed by clinical examination, stress radiography, ultrasound, the American Orthopaedic Foot and Ankle Society score (AOFAS), and Karlsson Ankle Functional score (KAFS) before surgery and at final follow-up.ResultsNineteen patients, ten men and nine women with mean age of 27.9 years (range, 19–41 years), underwent reconstruction. Mean follow-up was 30 months (range, 24–40 months). At final follow-up, all patients had returned to activity without instability, pain, or limited range of motion. On stress radiography, mean talar tilt angle decreased from 17.32° ± 3.58° before surgery to 4.16° ± 1.12° at follow-up (p < 0.001). Mean anterior drawer test (ADT) distance decreased from 9.79 ± 1.01 mm before surgery to 3.97 ± 0.99 mm at follow-up (p < 0.05). Mean AOFAS improved from 64.00 ± 18.43 to 90.32 ± 5.17 points (p < 0.001), and mean KAFS improved from 50.84 ± 16.73 to 90.89 ± 5.08 points (p < 0.001). Ultrasound showed the reconstructed ligaments maintained good continuity and excellent tension. No case of infection and immunological rejection was reported.ConclusionThis novel reconstruction technique takes into account the anatomical specialty of AFTL and CFL. This case series showed increased stability of the ankle in clinical and functional outcomes.Trial registrationThe trial registration number (TRN) and date of registration: ChiCTR-ORC-17010796, Mar 6th 2017. Retrospectively registered.

Clinical Outcomes and Return to Sport After Minimally Invasive Reconstruction of the Lateral Ligament Complex with Semitendinosus Tendon Autograft in Chronic Lateral Ankle Instability

“…Surgery is recommended in patients with chronic lateral ankle instability resistant to conservative methods, so as to restore stability, prevent intra-articular derangement and avoid early osteoarthritis [1,8,9,15,17]. The Broström technique, possibly associated with the Gould modification, is the gold standard of all proposed surgical repair techniques for chronic lateral ankle instability [1,12,31,32].…”

“…Anatomical repairs and reconstructions aim to restore as close as possible the normal anatomy. In non-anatomical reconstructions, autografts or allografts are used: the normal biomechanics of the ankle may be slightly altered in favour of greater stability [12,[16][17][18]. Recently, arthroscopic and combined arthroscopic-percutaneous approaches have been developed [2,[19][20][21][22].…”

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

“…eReferences 2, 3, 7, 8, 12, 26 –29, 35, 36, 38, 42 –44, 46, 69, 73, 74, 86, 90, 93, 95, 97, 102, 103, 105, 107, 114, 117 –119, 132, 134, 139, 142, 151, 153, 156, 157, 166, 179, 180, 184, 189, 191, 196, 197, 199, 206, 215, 216, 226, 229, 234.…”

“…gReferences 9, 15, 33, 35, 56, 57, 69, 80, 85, 94, 95, 119, 133, 137, 139, 148, 171, 179, 184, 186, 189, 191, 206, 216, 229.…”

Arthroscopic Remnant-Preserving Anterior Talofibular Ligament Reconstruction does not Improve the Short-term Function of Ankle

“…Dong et al reported the surgical effects of 20 cases receiving remnant-preserving lateral ankle ligament reconstruction, and suggested that, the ATFL-preserving remnant better recovered the function after ankle ligament reconstruction, and emphasized the importance of remnant-preserving surgery and favorable clinical follow-up results [28]. However, Wang et al performed ATFL reconstruction to treat 19 CLAI cases, no ATFL ligament remnant was preserved introperatively, and patients were followed up for an average of 30 months after surgery; their results suggested that, the AOFAS score was improved from 64.00 to 90.32 points, and the authors indicated that remnant-preservation was unnecessary in ATFL reconstruction [29]. Jiang et al…”