Efficacy and Safety of Split Peroneal Tendon Lateral Ankle Stabilization

Anatomic reconstruction of the lateral ligaments using allograft tendon and suspensory fixation for chronic lateral ankle instability with poor remnant quality: results and complications

PURPOSE

Treatment of chronic lateral ankle instability (CLAI) with poor remnant quality is challenging. The aim of the present study was to evaluate clinical results and complications of anatomic reconstruction of the lateral ligaments using allograft tendon and suspensory fixation in the treatment of such patients.

METHODS

One hundred and eight patients with CLAI, who were treated surgically using anatomic reconstruction with allograft tendon and suspensory fixation between April 2016 and January 2018 at our hospital, were retrospectively analysed. None of the patients had sufficient ligament remnants for the modified Broström procedure during the intraoperative evaluation. Eighteen patients were excluded. Seventeen patients were lost to follow-up and 73 patients completed the study. The mean duration of instability symptoms was 39.1 months (range, 6-480 months). The mean follow-up time was 57.5 months (range, 48-69 months). Clinical results were evaluated using the Karlsson scoring scale, American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot (AOFAS-AH) score, visual analogue scale (VAS), patients' subjective satisfaction, and incidence of complications. Mechanical stability was evaluated using the varus talar tilt angle (TTA) and anterior talar displacement (ATD).

RESULTS

The AOFAS-AH scores significantly improved from 67.7 ± 8.5 points to 89.8 ± 9.5 (p < 0.001). The Karlsson scoring scales evolved from 58.8 ± 16.5 to 88.4 ± 11.2 (p < 0.001). VAS scores significantly decreased from 2.9 ± 1.3 to 1.1 ± 1.0 (p < 0.001). On stress radiographs, TTA decreased from 15.1 ± 2.5 degrees to 5.8 ± 2.1 degrees (p < 0.001), whereas ATD reduced from 13.4 ± 2.9 mm to 5.7 ± 1.5 mm (p < 0.001). Patients' subjective satisfaction indicated 46 excellent, 20 good, 5 fair, and 2 bad results. Postoperatively, 15 cases (20.5%) did not achieve complete relief of discomfort or swelling, 9 cases (12.3%) experienced joint stiffness or decreased range of motion, and 6 cases (8.2%) had soft tissue irritation. Residual instability and reoperation are rare. Allograft rejection or wound infection was not observed.

CONCLUSION

For the CLAI patients with poor remnant quality, anatomic reconstruction of the lateral ligaments using allograft tendon and suspensory fixation is an effective procedure, while the top three complications in incidence were residual discomfort, joint stiffness, and soft tissue irritation.

LEVELS OF EVIDENCE

Level IV, retrospective case series.

A Comparison of Split Peroneus Brevis Tendon and Semitendinosus Allograft Tendon for Lateral Ankle Ligament Reconstruction

Lateral ankle instability is a debilitating condition that is often unresponsive to conservative therapy. Many techniques for operative repair have been proposed, most commonly performed as the Broström or modified Broström procedure. In patients with failed primary repair, hereditary collagen disorders, strenuous work activity, obesity, or ligamentous laxity, the Broström repair is less likely to be successful, and anatomic or nonanatomic reconstruction should be considered. The purpose of this study was to compare the functional outcomes and patient satisfaction between anatomic and nonanatomic reconstruction of the lateral ankle ligament complex for lateral ankle instability using a retrospective cohort study. We evaluated 64 ankles in 62 patients who underwent either a split peroneus brevis tendon (n = 36) or semitendinosus allograft tendon reconstruction (n = 28) for lateral ankle instability performed by the same surgeon. Postoperative American Orthopedic Foot and Ankle Society (p = .943) and patient satisfaction (p = .279) found no significant difference between either technique. Our results suggest that both split peroneus brevis and semitendinosus allograft may be viable alternatives for lateral ankle instability when primary ligamentous repair is not attainable.