Long-term follow-up of lateral reconstruction with extensor retinaculum flap for chronic ankle instability

Chronic instability is a common complication of lateral ankle sprains. Furthermore, patients often have unrecognized associated lesions affecting the ankle and subtalar joints. Many stabilizing surgical techniques have been described, each with variable results. This article reports the long-term results of ligamentous retensioning combined with reinforcement using an extensor retinaculum flap.

This is a retrospective, multicenter study. One hundred fifty cases were reviewed at a mean follow-up of 11 years. Functional results were assessed using the Karlsson score. Pre- and postoperative radiological assessment employed stress x-rays to measure varus tilt and anterior drawer and the Van Dijk classification to grade osteoarthrosis. The Stata 10 program was used for statistical analysis.

A thorough preoperative workup identified ligamentous lesions of the subtalar joint in 30% of cases. At review, 93% of patients were satisfied. Residual instability was present in only 4.8%. Radiographic analysis of both ankles revealed a differential in varus tilt of only 0.12° and in anterior drawer of 0.17~mm. There was no deterioration of the articular surfaces after 11 years of follow-up.

To the authors' knowledge, this is the largest series reported with such a follow-up. This technique addressed both lateral ankle and subtalar instability without sacrificing the peroneal tendons. It protected against progression of posttraumatic arthrosis and provided superior results to other reported techniques in terms of patient satisfaction and residual instability.