[Reconstruction of the lateral ankle ligaments with hamstring tendon autograft in patients with chronic ankle instability].

OBJECTIVE

Reconstruction of the anterior talofibular (ATFL) and calcaneofibular (CFL) ligament in patients with chronic lateral ankle instability.

INDICATIONS

Symptomatic chronic lateral ankle instability.

CONTRAINDICATIONS

Bony malalignment, advanced arthritic changes of the ankle joint, diabetic foot syndrome.

SURGICAL TECHNIQUE

Reconstruction of the ATFL and CFL with a free gracilisor or semitendinosus tendon graft through a V-shaped tunnel at the insertion site of the ATFL on the talar neck as well as a transfibular tunnel directed anterior to posterior through the fibula tip to a blind ending tunnel in the calcaneus at the insertion site of the CFL. Insertion of the graft through the talar tunnel, passing both graft ends through the fibular tunnel to the calcaneus. Fixation with a bioabsorbable screw.

POSTOPERATIVE MANAGEMENT

Short leg cast for 10-14 days and partial weight-bearing. Afterwards ankle brace for 6 weeks and functional physical therapy.

RESULTS

From December 2003 to August 2005, reconstruction of the ATFL and CFL with a hamstring tendon autograft was performed in 20 patients with chronic lateral instability of the ankle joint. All patients were evaluated after a mean follow-up time of 1.8 years (15-36 months). Clinical evaluation referred to the AOFAS score. Stress radiography was performed for objective assessment of lateral ankle stability. Postoperatively 19 of 20 patients reported good subjective stability with no further ankle sprains. The mean postoperative AOFAS score was 92 of 100 points (72-100). Stress radiography showed a significant reduction of both lateral ankle instability and talar tilt.