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Reconstruction of the Lateral Ankle Ligaments with Bone-Patellar Tendon Graft in Patients with Chronic Ankle Instability

A Preliminary Report

Kazuya Sugimoto, MD, PhD^,, Yoshinori Takakura, MD, PhD, Tsukasa Kumai, MD, PhD, Makoto Iwai, MD, PhD and Yasuhito Tanaka, MD, PhD

Saiseikai Nara Hospital, Nara, Japan

Presented at the British Orthopaedic Association and the Japanese Orthopaedic Association combined meeting, London, United Kingdom, October 2000.

Address correspondence and reprint requests to Kazuya Sugimoto, MD, PhD, Director, Department of Orthopaedic Surgery, Saiseikai Nara Hospital, Hachijo, Nara-shi, Nara 6308145, Japan

Background: Unsatisfactory long-term results have been reported after use of a Broström repair for patients with chronic ankle ligament insufficiency.

Hypothesis: Repair or reconstruction of both the anterior talofibular and calcaneofibular ligaments is essential for normal kinematics of the ankle-hindfoot.

Study Design: Case series.

Methods: Thirteen patients with chronic instability of the ankle were found at operation to have injuries of both the anterior talofibular and calcaneofibular ligaments, with a lack of healthy ligament margins suitable for suturing. Reconstruction of the ligaments was performed with bone-patellar tendon graft. The score devised by Good et al. was used to assess the patients’ clinical condition before the operation and at final follow-up.

Results: Before the operation, six patients had a grade 3 clinical condition and seven had a grade 4 condition. At a mean follow-up of 26.5 months, all patients had a grade 1 condition. The average talar tilt of the patients was improved from 18.4° ± 5.5° to 4.9° ± 2.6°, and the average anterior drawer sign was improved from 9.1 ± 2.6 mm to 5.8 ± 1.6 mm.

Conclusion: In cases of combined injuries, short-term results of reconstruction of the anterior talofibular and calcaneofibular ligaments using bone-split patellar tendon graft were good, with a low frequency of complications.

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