How to drill the talar tunnel in ATFL reconstruction?

Michels, Frederick; Guillo, Stéphane; Vanrietvelde, Frederik; Brugman, Eddy Maurice Paul; Stockmans, Filip

doi:10.1007/s00167-016-4018-0

Cited by 28 publications

(22 citation statements)

References 19 publications

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“…In these studies, the tension of the tendon graft was adjusted with the pulley effect technique which has higher requirements. According to the literature, there are many choices to drill the talar tunnel in the ATFL reconstruction; but the creation of a blind tunnel with a diameter of 5 mm and a depth of 20 mm toward the rear is the safest method which had been reported [26]. Categorical variables were reported as number (n) and percentage (%) Continuous variables were reported as mean ± SD…”

Section: Discussionmentioning

confidence: 99%

Using arthroscopy combined with fluoroscopic technique for accurate location of the bone tunnel entrance in chronic ankle instability treatment

Wei

Han

Kong

et al. 2021

BMC Musculoskelet Disord

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Background Minimally invasive reconstruction techniques are used for anatomical ligament construction of the lateral collateral ligament complex of the ankle, but the two key elements, the bone tunnel and the appropriate graft tension, for the identification of the anatomic location during the surgery are not clearly stated. Methods The patients with chronic ankle instability who received arthroscopic anatomic lateral ligament complex reconstruction were retrospectively analyzed. The anatomical location of the bone tunnel was performed under arthroscopy combined with fluoroscopy for accurate location of the bone tunnel entrance. The graft tension and routing were controlled under arthroscopic visualization. The clinical outcomes were assessed using the Karlsson-Peterson score, Sefton articular stability scale, and Visual Analogue Scale (VAS). The complications were recorded during the follow-up. Results A total of 18 patients were enrolled in this study. The mean follow-up was 33.33 ± 3.69 (range from 24 to 36) months. No patient had recurrence of ankle instability after the operation. According to the Sefton articular stability scale, 94.5% of the patients had excellent/good function. The mean value of the anterior drawer tests and the talar tilt angle examination were decreased. The mean of the Karlsson-Peterson score and the Visual Analogue Scale(VAS) score were both improved significantly. Conclusions The anatomic reconstruction of the ankle lateral ligament complex to treat chronic ankle instability using the arthroscopy combined with the fluoroscopic technique could improve the clinical functions, satisfaction, and reduced pain of patients.

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Section: Discussionmentioning

confidence: 99%

Using arthroscopy combined with fluoroscopic technique for accurate location of the bone tunnel entrance in chronic ankle instability treatment

Wei

Han

Kong

et al. 2021

BMC Musculoskelet Disord

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“…A blindended tunnel has been proposed. 12,14,15 Although the technique of blind-ended tunnel decreases the likelihood of cartilage damage to some extent but not to zero, it creates another problem that the graft cannot always be properly tensioned and fixated in the tunnel. We put the talar tunnel at the talar neck, which can completely avoid cartilage damage and make graft fixation very easy.…”

Section: Discussionmentioning

confidence: 99%

All Arthroscopic Remnant-Preserving Technique to Reconstruct the Lateral Ankle Ligament Complex

Gui

Jiang

et al. 2017

Arthroscopy Techniques

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Arthroscopic lateral ankle ligament reconstruction has been recently advocated. But this technique has not been popularized because of the technical complexity and potential iatrogenic injury. Because the talocalcaneal and calcaneofibular ligaments are extra-articular structures, how to efficiently view and address them is a difficult task. Limited dissection outside the capsule to form a working space is required, but aggressive dissection is harmful for tissue healing although it is helpful for visualization and instrumentation. Because almost the entire talar body is covered by articular cartilage, it is very difficult to safely make a bone tunnel without damaging the cartilage. The remnants of the lateral ankle ligament have proprioceptive sensors that are important for functional stability, but it is difficult to perform anatomical reconstruction arthroscopically while preserving them because of the narrow working space. Furthermore, how to properly tension the reconstructed ligaments in such a narrow working space is also a very difficult task. We have designed a technique that preserves the remnants of lateral ankle ligaments, and all of the above-mentioned problems have been successfully addressed. We have used this technique clinically, and only minor complications occurred.

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“…A microfracture awl is used to mark the center of the dissected footprint, and a 2.4-mm guidewire is inserted through the AAL portal to drill the talus toward the distal end of the medial malleolus. 20 The guidewire is then over-drilled using a drill bit with the same diameter as the graft end to create a 20-mm-deep talar tunnel ( Fig 2C).…”

Section: Step 4: Tunnel Creationmentioning

confidence: 99%

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Higashiyama

Sekiguchi

Takata

et al. 2020

Arthroscopy Techniques

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Arthroscopic techniques for anterior talofibular ligament (ATFL) repair and reconstruction have been developed in recent years. We simultaneously performed anatomical arthroscopic ATFL repair and reconstruction using a free tendon graft. The ATFL remnant is carefully dissected only at the footprint of the superior limb of the ATFL, and a bone tunnel is created on each side of the fibula and talus. A soft suture anchor with 2 sets of threads is inserted into the fibular tunnel. One set of threads is used to grab the ATFL remnant via a lasso-loop technique, whereas the other set of threads is used to introduce the ATFL graft. The graft is first fixed with a screw in the talar tunnel. Subsequently, the ATFL remnant and the graft are tightened simultaneously by pulling the 2 sets of suture anchor threads at the fibular tunnel and are fixed with a screw. This technique provides the possible advantages of remnant preservation and promotion of load sharing by the repaired ATFL remnant and the reconstructed ATFL graft.

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How to drill the talar tunnel in ATFL reconstruction?

Cited by 28 publications

References 19 publications

Using arthroscopy combined with fluoroscopic technique for accurate location of the bone tunnel entrance in chronic ankle instability treatment

Using arthroscopy combined with fluoroscopic technique for accurate location of the bone tunnel entrance in chronic ankle instability treatment

All Arthroscopic Remnant-Preserving Technique to Reconstruct the Lateral Ankle Ligament Complex

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

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