Mabit C, Pécout C, Arnaud J P
Services d'Orthopédie-Traumatologie I et II, Hôpital Universitaire Dupuytren, Limoges.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(1):70-75.
The authors present an original procedure for lateral ankle ligamentoplasty using peroneus tertius.
This muscle inconstantly present (90 p. cent), lies from the distal third of the anterior aspect of the fibula to the base of the fifth metatarsal with a caracteristic "hockey stick" shaped insertion. The width of the tendon is related to its length: in 60 per cent of cases the width exceeds 4 mm and makes the tendon biomechanically reliable. The procedure is carried out through a lateral approach. The tendon of the peroneus tertius is easily located under the extensor retinaculum. It is then dissected up to the muscle belly and its arterial supply. The neck of the talus and the lateral malleolus are exposed. A tunnel is drilled through the talar neck and the lateral malleolus and cautiously widened with a rasp. The tendon is passed through the malleolar and the talar tunnel. The transplant is thightened with the foot in neutral position (or fairly eversed) and sutured to it self.
Therefore this transplant restores in an anatomical position the anterior bundle of the lateral ligament of the ankle. It can be used for a ligamentoplasty of the subtalar joint as well: the transplant after crossing the talar neck is fixed at the lateral margin of the calcanus restoring the course of the cervical talo-calcaneal ligament.
This technique which is limited by anatomical consideration constitutes an alternative procedure compared with periosteal or peroneus brevis ligamentoplasty.
