J Korean Orthop Assoc.  2014 Feb;49(1):22-28. 10.4055/jkoa.2014.49.1.22.

Surgical Treatment of Chronic Ankle Lateral Instability: Reconstruction with Tenodesis or Tendon Graft

• Lee JY
• Park SS

• KMID: 2185244
• DOI: http://doi.org/10.4055/jkoa.2014.49.1.22

Abstract

Numerous reconstructive procedures have been described for treatment of chronic lateral ankle instability; however, controversy remains regarding the ideal surgical option. Numerous studies of the Brostrom procedure or its modifications have followed, reporting good to excellent results. However they have some limitations regarding the instabilities for over-weight, physically high demanding patients, failed anatomical repair, and particularly for significantly deficient or attenuated ligaments. This may indicate the need for non-anatomical reconstruction using peroneus brevis tendon or anatomical reconstruction using the allo/autograft tendon.

Keyword

ankle; chronic lateral instability; reconstruction; tenodesis or tendon graft

MeSH Terms

Ankle*
Humans
Ligaments
Tendons*
Tenodesis*
Transplants*

Figure

• 

  Figure 1 Various techniques of tenodesis for lateral ankle ligament reconstruction. (A) Watson-Jones procedure. (B) Evans procedure. (C) Chrisman-Snook procedure.

• 

  Figure 2 Anatomic reconstruction of the lateral ligament with the semitendinosus allograft tendon.26)

Reference

1. Karlsson J, Lansinger O. Lateral instability of the ankle joint. Clin Orthop Relat Res. 1992; 276:253–261.

2. Peters JW, Trevino SG, Renstrom PA. Chronic lateral ankle instability. Foot Ankle. 1991; 12:182–191.

3. Jung HG, Park JY, Park JT. Chronic lateral ankle instability. J Korean Foot Ankle Soc. 2012; 16:73–78.

4. Freeman MA. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg Br. 1965; 47:669–677.

5. Freeman MA, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br. 1965; 47:678–685.

6. Alanen J, Orava S, Heinonen OJ, Ikonen J, Kvist M. Peroneal tendon injuries. Report of thirty-eight operated cases. Ann Chir Gynaecol. 2001; 90:43–46.

7. Tohyama H, Yasuda K, Ohkoshi Y, Beynnon BD, Renstrom PA. Anterior drawer test for acute anterior talofibular ligament injuries of the ankle. How much load should be applied during the test? Am J Sports Med. 2003; 31:226–232.

8. Frost SC, Amendola A. Is stress radiography necessary in the diagnosis of acute or chronic ankle instability? Clin J Sport Med. 1999; 9:40–45.

9. Laurin C, Mathieu J. Sagittal mobility of the normal ankle. Clin Orthop Relat Res. 1975; 108:99–104.

10. Karlsson J, Eriksson BI, Renström PA. Subtalar ankle instability. A review. Sports Med. 1997; 24:337–346.

11. Broström L. Sprained ankles. VI. Surgical treatment of "chronic" ligament ruptures. Acta Chir Scand. 1966; 132:551–565.

12. DiGiovanni CW, Brodsky A. Current concepts: lateral ankle instability. Foot Ankle Int. 2006; 27:854–866.

13. Evans DL. Recurrent instability of the ankle; a method of surgical treatment. Proc R Soc Med. 1953; 46:343–344.

14. Colville MR, Marder RA, Zarins B. Reconstruction of the lateral ankle ligaments. A biomechanical analysis. Am J Sports Med. 1992; 20:594–600.

15. Rosenbaum D, Becker HP, Wilke HJ, Claes LE. Tenodeses destroy the kinematic coupling of the ankle joint complex. A three-dimensional in vitro analysis of joint movement. J Bone Joint Surg Br. 1998; 80:162–168.

16. Hollis JM, Blasier RD, Flahiff CM, Hofmann OE. Biomechanical comparison of reconstruction techniques in simulated lateral ankle ligament injury. Am J Sports Med. 1995; 23:678–682.

17. van der Rijt AJ, Evans GA. The long-term results of Watson-Jones tenodesis. J Bone Joint Surg Br. 1984; 66:371–375.

18. Younes C, Fowles JV, Fallaha M, Antoun R. Long-term results of surgical reconstruction for chronic lateral instability of the ankle: comparison of Watson-Jones and Evans techniques. J Trauma. 1988; 28:1330–1334.

19. Chrisman OD, Snook GA. Reconstruction of lateral ligament tears of the ankle. An experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure. J Bone Joint Surg Am. 1969; 51:904–912.

20. Elmslie RC. Recurrent subluxation of the ankle-joint. Ann Surg. 1934; 100:364–367.

21. Colville MR, Grondel RJ. Anatomic reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft. Am J Sports Med. 1995; 23:210–213.

22. Smith PA, Miller SJ, Berni AJ. A modified Chrisman-Snook procedure for reconstruction of the lateral ligaments of the ankle: review of 18 cases. Foot Ankle Int. 1995; 16:259–266.

23. Acevedo JI, Myerson MS. Modification of the Chrisman-Snook technique. Foot Ankle Int. 2000; 21:154–155.

24. Roderick C, Michael MS. Reconstuction of lateral ankle instability. In : Wülker N, Stephens M, Cracchiolo A, editors. An atlas of foot and ankle surgery. London: Taylor & Francis;2005. p. 281–289.

25. Coughlin MJ, Schenck RC Jr, Grebing BR, Treme G. Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft. Foot Ankle Int. 2004; 25:231–241.

26. Burks RT, Morgan J. Anatomy of the lateral ankle ligaments. Am J Sports Med. 1994; 22:72–77.

27. Sugimoto K, Takakura Y, Kumai T, Iwai M, Tanaka Y. Reconstruction of the lateral ankle ligaments with bone-patellar tendon graft in patients with chronic ankle instability: a preliminary report. Am J Sports Med. 2002; 30:340–346.

28. Jung HG, Kim TH, Park JY, Bae EJ. Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments using a semitendinosus tendon allograft and interference screws. Knee Surg Sports Traumatol Arthrosc. 2012; 20:1432–1437.

29. Paterson R, Cohen B, Taylor D, Bourne A, Black J. Reconstruction of the lateral ligaments of the ankle using semi-tendinosis graft. Foot Ankle Int. 2000; 21:413–419.

30. Marrale J, Morrissey MC, Haddad FS. A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2007; 15:690–704.

31. Hennrikus WL, Mapes RC, Lyons PM, Lapoint JM. Outcomes of the Chrisman-Snook and modified-Broström procedures for chronic lateral ankle instability. A prospective, randomized comparison. Am J Sports Med. 1996; 24:400–404.

32. Karlsson J, Eriksson BI, Bergsten T, Rudholm O, Swärd L. Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint. Am J Sports Med. 1997; 25:48–53.

33. Hamilton WG, Thompson FM, Snow SW. The modified Brostrom procedure for lateral ankle instability. Foot Ankle. 1993; 14:1–7.

34. Snook GA, Chrisman OD, Wilson TC. Long-term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle. J Bone Joint Surg Am. 1985; 67:1–7.

35. Krips R, van Dijk CN, Halasi PT, et al. Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a multicenter study. Foot Ankle Int. 2001; 22:415–421.

36. Caprio A, Oliva F, Treia F, Maffulli N. Reconstruction of the lateral ankle ligaments with allograft in patients with chronic ankle instability. Foot Ankle Clin. 2006; 11:597–605.

37. Sammarco VJ. Complications of lateral ankle ligament reconstruction. Clin Orthop Relat Res. 2001; 391:123–132.