Lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PAN Yuehai , QU Zhigang , BI Benjun , GAO Fei , HUANG Heng ,  DONG Quanyu

Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China;

Corresponding author：

DONG Quanyu, Email: dongquanyu826@163.com

Keywords：

Chronic ankle instability; lateral ligament; ligament reconstruction; peroneus longus tendon; autograft

DOI：

10.7507/1002-1892.202002008

Video：

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Objective To assess the effectiveness of lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability.Methods Between September 2014 and November 2018, 32 patients (32 sides) with chronic lateral ankle instability were treated with lateral ankle ligament reconstruction by using autogenous anterior half of the peroneus longus tendon. There were 25 males and 7 females, with an average age of 28.5 years (range, 20-51 years). The disease duration was 6-41 months (mean, 8.9 months). The preoperative Karlsson-Peterson ankle score was 53.7±9.7. The talar tilt angle was (14.9±3.7)°, and the anterior talar translation was (8.2±2.8) mm. Six patients combined with osteochondral lesion of talus and 4 patients combined with bony impingement.Results All incisions healed by first intention postoperatively. All patients were followed up 12-53 months (mean, 22.7 months). At last follow-up, the Karlsson-Peterson ankle score was 85.2±9.6; the talar tilt angle was (4.3±1.4)°; the anterior talar translation was (3.5±1.1) mm. There were significant differences in all indexes between pre- and post-operation (P<0.05). Seventeen patients were very satisfied with the results, 10 patients were satisfied, 4 patients were normal, and 1 patient was unsatisfied. After operation, the ankle sprain occurred in 7 cases, the tenderness around the compression screws at calcaneus in 5 cases, the anterolateral pain of ankle joint over 6 months in 4 cases. No patient had discomfort around the reciepient sites. At last follow-up, the ultrasonography examination showed that there was no significant difference in the density and diameter between bilateral peroneus longus tendons in 12 cases.Conclusion For chronic lateral ankle instability, the lateral ankle ligament reconstruction with the autogenous partial peroneus longus tendon is a safe and effective surgical option.

Citation： PAN Yuehai, QU Zhigang, BI Benjun, GAO Fei, HUANG Heng, DONG Quanyu. Lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1114-1119. doi: 10.7507/1002-1892.202002008 Copy

1.	Li H, Song Y, Li H, et al. Outcomes after anatomic lateral ankle ligament reconstruction using allograft tendon for chronic ankle instability: a systematic review and meta-analysis. J Foot Ankle Surg, 2020, 59(1): 117-124.
2.	Porter DA, Kamman KA. Chronic lateral ankle instability: open surgical management. Foot Ankle Clin, 2018, 23(4): 539-554.
3.	易刚, 扶世杰, 杨静, 等. 全关节镜下与改良开放式 Broström 锚钉修复距腓前韧带的疗效比较. 中国修复重建外科杂志, 2019, 33(12): 1503-1509.
4.	陈守勃, 华英汇. 前距腓韧带修复术治疗踝关节外侧不稳定疗效分析. 中国修复重建外科杂志, 2017, 31(4): 427-431.
5.	张言, 梁晓军. 慢性踝关节外侧不稳的解剖修复治疗进展. 中国修复重建外科杂志, 2016, 30(12): 1551-1555.
6.	Teixeira J, Guillo S. Arthroscopic treatment of ankle instability- Allograft/autograft reconstruction. Foot Ankle Clin, 2018, 23(4): 571-579.
7.	Ahn JH, Choy WS, Kim HY. Reconstruction of the lateral ankle ligament with a long extensor tendon graft of the fourth toe. Am J Sports Med, 2011, 39(3): 637-644.
8.	Hintermann B, Renggli P. Anatomic reconstruction of the lateral ligaments of the ankle using a plantaris tendon graft. Orthopade, 1999, 28(9): 778-784.
9.	Boyer DS, Younger AS. Anatomic reconstruction of the lateral ligament complex of the ankle using a gracilis autograft. Foot Ankle Clin, 2006, 11(3): 585-595.
10.	Dierckman BD, Ferkel RD. Anatomic reconstruction with a semitendinosus allograft for chronic lateral ankle instability. Am J Sports Med, 2015, 43(8): 1941-1950.
11.	Krips R, van Dijk CN, Halasi T, et al. Anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a 2- to 10-year follow-up, multicenter, study. Knee Surg Sports Traumatol Arthrosc, 2000, 8(3): 173-179.
12.	Takahashi T, Nakahira M, Kaho K, et al. Anatomical reconstruction of chronic lateral ligament injury of the ankle using pedicle tendon of the extensor digitorum longus. Arch Orthop Trauma Surg, 2003, 123(4): 175-179.
13.	Pagenstert GI, Hintermann B, Knupp M. Operative management of chronic ankle instability: plantaris graft. Foot Ankle Clin, 2006, 11(3): 567-583.
14.	Zhao J, Huangfu X. The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source. Am J Sports Med, 2012, 40(3): 662-671.
15.	Jung HG, Kim NR, Kim TH, et al. Magnetic resonance imaging and stress radiography in chronic lateral ankle instability. Foot Ankle Int, 2017, 38(6): 621-626.
16.	Jolman S, Robbins J, Lewis L, et al. Comparison of magnetic resonance imaging and stress radiographs in the evaluation of chronic lateral ankle instability. Foot Ankle Int, 2017, 38(4): 397-404.
17.	Karlsson J, Peterson L. Evaluation of ankle joint function: the use of a scoring scale. The Foot, 1991, 1(1): 15-19.
18.	Jung HG, Kim TH, Park JY, et al. Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments using a semitendinosus tendon allograft and interference screws. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8): 1432-1437.
19.	Kim BS, Choi WJ, Kim YS, et al. The effect of an ossicle of the lateral malleolus on ligament reconstruction of chronic lateral ankle instability. Foot Ankle Int, 2010, 31(3): 191-196.
20.	Takao M, Oae K, Uchio Y, et al. Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft: a new technique using an interference fit anchoring system. Am J Sports Med, 2005, 33(6): 814-823.
21.	Youn H, Kim YS, Lee J, et al. Percutaneous lateral ligament reconstruction with allograft for chronic lateral ankle instability. Foot Ankle Int, 2012, 33(2): 99-104.
22.	Kennedy JG, Smyth NA, Fansa AM, et al. Anatomic lateral ligament reconstruction in the ankle: a hybrid technique in the athletic population. Am J Sports Med, 2012, 40(10): 2309-2317.
23.	Budny AM, Schuberth JM. Autologous split peroneus longus lateral ankle stabilization. J Foot Ankle Surg, 2012, 51(5): 588-592.
24.	Petersen W, Bobka T, Stein V, et al. Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand, 2000, 71(2): 168-174.

1. Li H, Song Y, Li H, et al. Outcomes after anatomic lateral ankle ligament reconstruction using allograft tendon for chronic ankle instability: a systematic review and meta-analysis. J Foot Ankle Surg, 2020, 59(1): 117-124.
2. Porter DA, Kamman KA. Chronic lateral ankle instability: open surgical management. Foot Ankle Clin, 2018, 23(4): 539-554.
3. 易刚, 扶世杰, 杨静, 等. 全关节镜下与改良开放式 Broström 锚钉修复距腓前韧带的疗效比较. 中国修复重建外科杂志, 2019, 33(12): 1503-1509.
4. 陈守勃, 华英汇. 前距腓韧带修复术治疗踝关节外侧不稳定疗效分析. 中国修复重建外科杂志, 2017, 31(4): 427-431.
5. 张言, 梁晓军. 慢性踝关节外侧不稳的解剖修复治疗进展. 中国修复重建外科杂志, 2016, 30(12): 1551-1555.
6. Teixeira J, Guillo S. Arthroscopic treatment of ankle instability- Allograft/autograft reconstruction. Foot Ankle Clin, 2018, 23(4): 571-579.
7. Ahn JH, Choy WS, Kim HY. Reconstruction of the lateral ankle ligament with a long extensor tendon graft of the fourth toe. Am J Sports Med, 2011, 39(3): 637-644.
8. Hintermann B, Renggli P. Anatomic reconstruction of the lateral ligaments of the ankle using a plantaris tendon graft. Orthopade, 1999, 28(9): 778-784.
9. Boyer DS, Younger AS. Anatomic reconstruction of the lateral ligament complex of the ankle using a gracilis autograft. Foot Ankle Clin, 2006, 11(3): 585-595.
10. Dierckman BD, Ferkel RD. Anatomic reconstruction with a semitendinosus allograft for chronic lateral ankle instability. Am J Sports Med, 2015, 43(8): 1941-1950.
11. Krips R, van Dijk CN, Halasi T, et al. Anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a 2- to 10-year follow-up, multicenter, study. Knee Surg Sports Traumatol Arthrosc, 2000, 8(3): 173-179.
12. Takahashi T, Nakahira M, Kaho K, et al. Anatomical reconstruction of chronic lateral ligament injury of the ankle using pedicle tendon of the extensor digitorum longus. Arch Orthop Trauma Surg, 2003, 123(4): 175-179.
13. Pagenstert GI, Hintermann B, Knupp M. Operative management of chronic ankle instability: plantaris graft. Foot Ankle Clin, 2006, 11(3): 567-583.
14. Zhao J, Huangfu X. The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source. Am J Sports Med, 2012, 40(3): 662-671.
15. Jung HG, Kim NR, Kim TH, et al. Magnetic resonance imaging and stress radiography in chronic lateral ankle instability. Foot Ankle Int, 2017, 38(6): 621-626.
16. Jolman S, Robbins J, Lewis L, et al. Comparison of magnetic resonance imaging and stress radiographs in the evaluation of chronic lateral ankle instability. Foot Ankle Int, 2017, 38(4): 397-404.
17. Karlsson J, Peterson L. Evaluation of ankle joint function: the use of a scoring scale. The Foot, 1991, 1(1): 15-19.
18. Jung HG, Kim TH, Park JY, et al. Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments using a semitendinosus tendon allograft and interference screws. Knee Surg Sports Traumatol Arthrosc, 2012, 20(8): 1432-1437.
19. Kim BS, Choi WJ, Kim YS, et al. The effect of an ossicle of the lateral malleolus on ligament reconstruction of chronic lateral ankle instability. Foot Ankle Int, 2010, 31(3): 191-196.
20. Takao M, Oae K, Uchio Y, et al. Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft: a new technique using an interference fit anchoring system. Am J Sports Med, 2005, 33(6): 814-823.
21. Youn H, Kim YS, Lee J, et al. Percutaneous lateral ligament reconstruction with allograft for chronic lateral ankle instability. Foot Ankle Int, 2012, 33(2): 99-104.
22. Kennedy JG, Smyth NA, Fansa AM, et al. Anatomic lateral ligament reconstruction in the ankle: a hybrid technique in the athletic population. Am J Sports Med, 2012, 40(10): 2309-2317.
23. Budny AM, Schuberth JM. Autologous split peroneus longus lateral ankle stabilization. J Foot Ankle Surg, 2012, 51(5): 588-592.
24. Petersen W, Bobka T, Stein V, et al. Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand, 2000, 71(2): 168-174.

Chinese Journal of Reparative and Reconstructive Surgery

Lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability

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