Surgical revision after failed lateral ankle reconstruction.

Ten patients were treated with revision ankle ligament reconstruction from 1989 through 1994 for recurrent symptomatic instability of the ankle after failure of a primary reconstruction. There were seven female and three male patients with an average age of 28 years. In four patients, symptoms developed shortly after the first reconstruction and in six patients, symptoms developed 56.2 months (average) after the initial reconstruction surgery. The average follow-up was 14 months after revision surgery. All patients had significant functional impairment before surgery and all failed to respond to conservative treatment, which included physical therapy and bracing. Seven revision ligament reconstructions included the use of a tendon graft, including the peroneus brevis, accessory peroneus, plantaris, and peroneus tertius. All revision procedures were modifications of the Elmslie procedure, (Sammarco-DiRaimondo). In addition, three Brostrom-Gould procedures were performed. The average follow-up was 31 months. All patients had clinical stability of the ankle following revision reconstruction. Nine patients (90%) returned to their previous functional level. After surgery, two patients had minimal pain and mononeuritis multiplex developed in one patient. The outcome of revision ankle ligament reconstruction compares favorably with reports for primary ankle reconstruction. Revision ankle reconstruction is a good procedure for selected patients. It is an appropriate option when conservative therapy fails to relieve recurrent symptoms of ankle instability following primary reconstruction.