Anatomical Reconstruction of the Lateral Ligaments of the Ankle with a Gracilis Autograft

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Abstract
Background: Few anatomical and minor invasive procedures have been reported for surgical reconstruction of the lateral ligaments to treat lateral instability of the ankle. Furthermore, there are no standards according to which ligaments should be reconstructed. Hypothesis: A new technique for anatomically reconstructing the lateral ligaments of the ankle using an interference fit anchoring system and determining which ligaments need to be reconstructed according to the results of standard stress radiography of the talocrural and subtalar joints will be effective for treating lateral instability of the ankle. Study Design: Case series; level of evidence, 4. Methods: Twenty-one patients with lateral instability of the ankle underwent surgery using the proposed interference fit anchoring system. Standard stress radiographs of the subtalar joint were performed, and if the talocalcaneal angle was less than 10°, only the anterior talofibular ligament was reconstructed; if there was a 10° or greater opening of the talocalcaneal angle, both the anterior talofibular ligament and the calcaneofibular ligament were reconstructed. Results: In the 17 patients who received only the anterior talofibular ligament reconstruction, the mean talar tilt angle on standard stress radiography of the talocrural joint was 14.5°± 1.7° before surgery and 2.6°± 0.8° 2 years after surgery (P <. 0001). For the 4 patients who had both the anterior talofibular ligament and calcaneofibular ligament reconstructed, the mean talar tilt angle was 16.5°± 1.5° before surgery and 3.0°± 0.5° 2 years after surgery (P =. 0015). The overall mean talocalcaneal angle on standard stress radiography of the subtalar joint was 11.3°± 1.4° before surgery and 3.5°± 0.8° 2 years after surgery (P =. 0060). Conclusion: The proposed system has several advantages, including anatomical reconstruction with normal stability and range of motion restored, the need for only a small incision during the reconstruction, and sufficient strength at the tendon graft-bone tunnel junction, in comparison with the tension strength of the lateral ligaments of the ankle.

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