Chronic lateral ankle instability surgical repairs: The long term prospective - 07/06/10

Doi : 10.1016/j.otsr.2010.04.004

C. Mabit ^a,^⁎ , Y. Tourné ^b, J.-L. Besse ^c, F. Bonnel ^d, E. Toullec ^e, F. Giraud ^f, J. Proust ^a, F. Khiami ^g, C. Chaussard ^h, C. Genty ⁱ
Sofcot (French Society of Orthopedic and Traumatologic Surgery)
^a Orthopedic and Traumatologic Surgery Department, Dupuytren Teaching Hospital, 42, avenue Martin-Luther-King, 87042 Limoges cedex, France
^b République Surgery Group, 15, rue de la République, 38000 Grenoble, France
^c Lyon-1 University, INRETS, LBMC UMRT 9406, Lyon-Sud Hospital, 69495 Pierre-Bénite cedex, France
^d Anatomy Laboratory, 4, rue de l’École de médecine, 34000 Montpellier cedex 5, France
^e Du Tondu Private Hospital, 151, rue du Tondu, 33000 Bordeaux, France
^f Orthopedic Department, Lille Teaching Hospital, rue Philippe-Maraché, 59037 Lille cedex, France
^g Orthopedic Surgery Department, Pitié-Salpétrière Teaching Hospital, 89, boulevard de l’Hôpital, 75013 Paris cedex, France
^h Orthopedic Surgery Department, South Hospital, 1, rue de Grugliasco, 38009 Grenoble, France
ⁱ SIIM Biostatistics Laboratory, Teaching Hospital, 38043 Grenoble cedex 9, France

Corresponding author.

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Summary

The present study sought to assess the clinical and radiological results and long-term joint impact of different techniques of lateral ankle ligament reconstruction.

Material and methods

A multicenter retrospective review was performed on 310 lateral ankle ligament reconstructions, with a mean 13-year-follow-up (minimum FU: 5 years). Male subjects (53%) and sports trauma (78%) predominated. Mean duration of instability was 92 months; mean age at surgery was 28 years. Twenty-eight percent of cases showed subtalar joint involvement. Four classes of surgical technique were distinguished: C1, direct capsular ligamentous complex reattachment; C2, augmented repair; C3, ligamentoplasty using part of the peroneus brevis tendon and C4, ligamentoplasty using the whole peroneus brevis tendon. Clinical and functional assessment used Karlsson and Good-Jones-Livingstone scores; radiologic assessment combined centered AP and lateral views, hindfoot weight-bearing Méary views and dynamic views (manual technique, Telos^® or self-imposed varus).

Results

The majority of results (92%) were satisfactory. The mean Karlsson score of 90 [19–100] (i.e., 87% good and very good results) correlated with the subjective assessment, and did not evolve over time. Postoperative complications (20%), particularly when neurologic, were associated with poorer results. Control X-ray confirmed the very minor progression in degenerative changes, with improved stability; there was, however, no correlation between functional result and residual laxity on X-ray. Unstable and painful ankles showed poorer clinical results and more secondary osteoarthritis. Analysis by class of technique found poorer results in C4-type plasties and poorer control of laxity on X-ray in C1-type tension restoration.

Discussion

The present results confirm the interest of lateral ankle ligamentoplasty in the management of instability and protection against secondary osteoarthritis, and of precise lesion assessment (CT-scan/MRI) to adapt surgery to the ligamentary and associated lesions.