[The periosteal flap augmentation technique in chronic lateral ankle instability]

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Anatomy

Background:

• Chronic lateral ankle instability often results from mechanical incompetence of the fibulotalar and fibulocalcaneal ligaments.
• Intra-articular pathologies, such as osteochondral lesions, frequently accompany lateral ankle instability.
• Anatomic repair and augmentation are crucial for restoring stability and function.

Purpose of the Study:

• To describe an anatomic repair of the lateral ligament complex of the ankle joint.
• To augment the repair using an autologous pedicled periosteal flap from the distal fibula.
• To address intra-articular pathologies concurrently with ligamentous repair.

Main Methods:

• Diagnostic arthroscopy to identify and treat intra-articular issues and assess ligamentous integrity.
• Open exposure and anatomic reinsertion of ruptured lateral ankle ligaments.
• Augmentation using a pedicled periosteal strip from the distal fibula, secured with suture anchors, screws, or interference screws.

Main Results:

• High success rates (>90%) in restoring ligamentous ankle stability.
• Good to excellent overall patient outcomes (>90%) with minimal complications.
• Outcomes comparable to free tendon graft techniques, particularly in high-demand patients.

Conclusions:

• Anatomic repair combined with periosteal augmentation is a reliable technique for chronic lateral ankle instability.
• This method effectively restores ankle stability and function, even in cases with poor ligament quality.
• The procedure offers a viable alternative for patients with high functional demands.