[Surgical treatment of chronic upper ankle joint instability in childhood]

The Department of Traumatology of the Hanover Medical School treated 347 patients having chronic instability or second stage rupture of the fibular ligament system, by surgery, during 1971 through 1986. Children were represented by one-seventh of the total number of patients only (13%; n = 44); however, in children the preoperative and intraoperative findings are different from normal findings and must be treated surgically in a special way. Whereas in adults old osseous/osteochondral ligament tears are apt to be rare (16% of the cases), they can be seen in children in almost every second case (18 of 44). Surgical approach requires a step-by-step procedure to achieve maximum stability and minimum functional loss. First Choice: Direct reconstruction of the ligament in case of ligaments which are present but have not healed correctly from a biomechanical point of view (e.g. pseudoarthroticosseous ligament tear) or in case of second-stage rupture (n = 20). Second Choice: Double periosteal flap plasty in case of necessary replacement of only one ligament (n = 13). Third Choice: Tenodesis of m. peroneus brevis using only half of the tendon chip while sparing the epiphysis if the condition persists for many years, or if ligaments cannot be reconstructed or replaced intraoperatively or if there is a combined instability of the ankle joint and the talo-calcaneonavicular joint (n = 11). In almost 90% of the cases very good to good results were obtained after five years, assessed according to a 100-point schema.