Augmented Ligament Reconstruction Partially Restores Hindfoot and Midfoot Kinematics After Lateral Ligament Ruptures

Abstract

Background: Altered kinematics and persisting ankle instability have been associated with degenerative changes and osteochondral lesions. Purpose: To study the effect of ligament reconstruction surgery with suture tape augmentation (isolated anterior talofibular ligament [ATFL] vs combined ATFL and calcaneofibular ligament [CFL]) after lateral ligament ruptures (combined ATFL and CFL) on foot-ankle kinematics during simulated gait. Study Design: Controlled laboratory study. Methods: Five fresh-frozen cadaveric specimens were tested in a custom-built gait simulator in 5 different conditions: intact, ATFL rupture, ATFL-CFL rupture, ATFL-CFL reconstruction, and ATFL reconstruction. For each condition, range of motion (ROM) and the average angle (AA) in the hindfoot and midfoot joints were calculated during the stance phase of normal and inverted gait. Results: Ligament ruptures mainly changed ROM in the hindfoot and the AA in the hindfoot and midfoot and influenced the kinematics in all 3 movement directions. Combined ligament reconstruction was able to restore ROM in inversion-eversion in 4 of the 5 joints and ROM in internal-external rotation and dorsiflexion-plantarflexion in 3 of the 5 joints. It was also able to restore the AA in inversion-eversion in 2 of the 5 joints, the AA in internal-external rotation in all joints, and the AA in dorsiflexion-plantarflexion in 1 of the joints. Isolated ATFL reconstruction was able to restore ROM in inversion-eversion and internal-external rotation in 3 of the 5 joints and ROM in dorsiflexion-plantarflexion in 2 of the 5 joints. Isolated reconstruction was also able to restore the AA in inversion-eversion and dorsiflexion-plantarflexion in 2 of the joints and the AA in internal-external rotation in 3 of the joints. Both isolated reconstruction and combined reconstruction were most successful in restoring motion in the tibiocalcaneal and talonavicular joints and least successful in restoring motion in the talocalcaneal joint. However, combined reconstruction was still better at restoring motion in the talocalcaneal joint than isolated reconstruction (1/3 for ROM and 1/3 for the AA with isolated reconstruction compared to 1/3 for ROM and 2/3 for the AA with combined reconstruction). Conclusion: Combined ATFL-CFL reconstruction showed better restored motion immediately after surgery than isolated ATFL reconstruction after a combined ATFL-CFL rupture. Clinical Relevance: This study shows that ligament reconstruction with suture tape augmentation is able to partially restore kinematics in the hindfoot and midfoot at the time of surgery. In clinical applications, where the classic Broström-Gould technique is followed by augmentation with suture tape, this procedure may protect the repaired ligament during healing by limiting excessive ROM after a ligament rupture.

Magnetic Resonance Imaging T2* Mapping of the Talar Dome and Subtalar Joint Cartilage 3 Years After Anterior Talofibular Ligament Repair or Reconstruction in Chronic Lateral Ankle Instability

“…Furthermore, the mean T2* values of MC, MP, LC, LP, subCT, subCC, subLT, and subLC cartilage compartments in the reconstruction group at follow-up were significantly greater than those in the control group. A recent cadaveric study performed by Boey et al 3 demonstrated that ATFL reconstruction and ATFL + calcaneofibular ligament reconstruction were not able to fully restore the abnormal sagittal plane kinematics in the tibiotalar joint, which may cause joint loads to be shifted to infrequently loaded areas of the cartilage. 7 Prisk et al 35 performed a cadaveric study and concluded that graft reconstruction limited the coupled axial rotation of the hindfoot and increased the medial shift in the center of pressure at 20° of plantarflexion relative to the intact condition.…”

Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium‐ and Long‐Term Functional Follow‐Up

“…(iv) The anatomical repair of ATFL is realized without affecting the range of motion of the ankle and subtalar joint. (v) Operating in the safe zone is preferred as it does not affect the mobility of the ankle and the subtalar join. (vi) Suture intensity and fixation effect of ATFL can be observed under the arthroscopy.…”

Improved Outcome and Earlier Return to Activity After Suture Tape Augmentation Versus Broström Repair for Chronic Lateral Ankle Instability? A Systematic Review

“…34 Thus, it was J o u r n a l P r e -p r o o f hypothesized that suture tape augmentation could improve ankle stability by increasing stability of the reconstructed ATFL and protecting the ligament. 15,16,17,18,19 A cadaveric study by Viens et al 6 was able to demonstrate that strength and stiffness of the suture tape augmented construct was not significantly different to the native ATFL.…”

“…13,14 Suture tape augmentation or "internal bracing" is performed by using ultra high molecular weight polyethylene/polyester (UHMWPE) tapes and knotless bone anchors that are supposed to contribute to scar tissue formation by restoration of ankle stability and hence protect the repaired ligament during healing. 15,16,17,18,19 The aim of this study was to determine whether the use of suture tape augmentation would lead to improved clinical outcomes, increased stability, shorter postoperative immobilization J o u r n a l P r e -p r o o f and earlier return to activity and sports compared to Broström repair in surgical treatment of chronic lateral ankle instability (CLAI).…”