Extensor Retinaculum Flap and Fibular Periosteum Ligamentoplasty After Failed Surgery for Chronic Lateral Ankle Instability

Abstract

Background: The anterior talofibular ligament and the calcaneofibular ligament are 2 of the most frequently injured structures in sports, being damaged in 30% to 45% of all sports injuries. Most reconstructive procedures are successful but can deteriorate with time and can lead to low-grade radiographic degeneration. Methods: We operated on 26 consecutive patients from 2001 to 2008 who had failed previous surgical procedures for the lateral ligamentous complex of the ankle, with an average of 104 (range, 75-140) months. Results: The overall functional rating was excellent in 14 ankles, good in 10, fair in 1, and poor in 1. Twenty-four patients (92.3%) were satisfied with the procedure and 15 (57.7%) were able to return to their preinjury level of activity. Local complications were detected in 2 patients who presented with skin necrosis; 1 patient developed severe reflex sympathetic dystrophy. Conclusion: Revision surgery for the management of failure after surgical treatment of chronic lateral ankle instability is under debate, and the literature is devoid of clinical studies with long-term follow-up. The technique described offers a high rate of long-term excellent and good results, with a low rate of complications and a good rate of return to preinjury level. Level of Evidence: Level IV, retrospective case series.

Anterior Talofibular Ligament All-Inside Arthroscopic Reconstruction with InternalBrace™ for Chronic Lateral Ankle Instability

“…In this study, reconstruction with InternalBrace™ augmentation was used, which can preserve the original structure and provide effective stability. In terms of anatomical reconstruction, the classic Broström method [ 21 , 22 ] performs contraction and overlapping sutures on the residual end of the injured ligament. Although the efficacy is satisfactory, the strength will decrease with time.…”

Anatomical Study of the Inferior Extensor Retinaculum and the Oblique Superolateral Band: Implications for the Brostrom-Gould Procedure

“…Therefore, to strengthen the repair of the ligament, some orthopaedic surgeons created an IER flap as a graft, by using part of the IER tissue and fixing it to the fibular canal, the follow-up effect after surgery was considerable [23,24]. In a recent study, Pintore et al [25] used an IER flap combined with fibular periosteal flap to treat patients with failed chronic ankle surgery. Patients had a 92.3% satisfaction rate at the last follow-up.…”

Clinical Assessment of Ankle Instability: An Update on Which, When, Why

“…These can be divided into direct anatomical repair/reconstruction (DAR) and non-anatomical repair/ reconstruction (NAR) procedures. Both DAR and NAR can involve the use of allograft autografts or synthetic ligaments (29). The gold standard procedure for ATLF reconstruction is the Broström-Gould procedure combined with retinal extensor transfer, although this association has recently been questioned (30).…”