Surgical treatment of lateral ankle instability syndrome

Lateral ankle instability syndrome is defined by pain and instability caused by ligament laxity. Anterior talofibular ligament laxity, with or without calcaneofibular laxity and other abnormalities, is often present in conjunction with peroneus brevis tendon tears, abnormal ligament placement, tibialis posterior tendon tears, osteochondritis dissecans, arthritis, synovitis, loose bodies, and tarsal coalition. Surgical reconstructions were performed on 43 ankles using a split peroneus brevis tendon graft routed through osseous tunnels in the talus, fibula, and calcaneus and resutured to the reconstructed anterior talofibular and calcaneofibular ligaments. The tunnel locations, transfer routes, and tendon reinforcement were modifications based on the Elmslie procedure. Good and excellent results were achieved in 91% of the patients. Ninety-eight percent of the patients achieved stability. Followup was from 9 months to 11 years. Twenty-one patients had preoperative and intraoperative findings that required additional procedures. Thorough evaluation of patients with lateral ankle instability syndrome increases the frequency of finding associated abnormalities, which if left uncorrected, may adversely affect the outcome of surgery.