Lateral instability of the ankle joint

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Rehabilitative Medicine

Background:

• Acute lateral ankle ligament ruptures often respond well to nonoperative management including physiotherapy and peroneal strengthening.
• A significant minority (10-20%) of patients may experience persistent functional instability despite appropriate nonoperative treatment.
• Chronic functional instability of the ankle may necessitate surgical intervention, particularly for individuals with high functional demands.

Purpose of the Study:

• To evaluate surgical treatment options for chronic lateral ankle instability.
• To compare the long-term efficacy of different lateral ankle ligament reconstruction techniques.

Main Methods:

• Review of surgical procedures for chronic lateral ankle instability, focusing on tenodeses (e.g., Evans, Watson-Jones, Chrisman-Snook) and anatomic ligament reconstruction.
• Analysis of reported short-term and long-term outcomes for various surgical techniques.

Main Results:

• While tenodeses like Evans and Watson-Jones show good short-term results, their long-term outcomes are often suboptimal.
• Anatomic ligament reconstruction, involving shortening, reinsertion, and imbrication of elongated ligaments, presents a simpler alternative.
• This anatomic approach has demonstrated favorable long-term results.

Conclusions:

• Anatomic ligament reconstruction may offer superior long-term outcomes compared to more complex tenodesis procedures for chronic lateral ankle instability.
• For patients with persistent functional deficits after nonoperative treatment, anatomic reconstruction is a promising surgical option.