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Treatment algorithm of chronic ankle and subtalar instability
H Thermann1, H Zwipp, H Tscherne
1Trauma Department, Hannover Medical School, Germany.
Foot & Ankle International
|March 1, 1997
Summary
Both reconstructive and Evans tenodesis procedures effectively treat chronic ankle instability. Evans tenodesis showed reduced talar tilt, while both methods yielded excellent patient outcomes.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanics
Background:
- Chronic ankle instability affects numerous patients, impacting quality of life and athletic performance.
- Surgical interventions are often necessary to restore joint stability and function.
- Various surgical techniques exist, including reconstructive procedures, Evans tenodesis, and Christman/Snook procedures.
Purpose of the Study:
- To compare the efficacy of reconstructive procedures versus Evans tenodesis for chronic ankle instability.
- To evaluate the outcomes of Christman/Snook procedures for subtalar instability.
- To assess long-term functional results and patient satisfaction after surgical treatment.
Main Methods:
- Retrospective review of 223 patients undergoing ankle or subtalar instability surgery between 1972 and 1985.
- Surgical procedures included reconstructive procedures (n=102), Evans tenodesis (n=87), and Christman/Snook procedures (n=34).
- Follow-up included standard and stress radiography, subjective patient evaluation, and objective functional assessments.
Main Results:
- No patient exhibited clinically significant ankle instability post-surgery in either group.
- Evans tenodesis resulted in a mean 3.3 degrees less talar tilt compared to reconstructive procedures.
- 90% of patients in both ankle instability groups achieved good or excellent results.
- Christman/Snook procedures for subtalar instability showed a mean supination deficit of 7.2 degrees in 20 patients, with 31 of 34 patients rated good or excellent.
Conclusions:
- Both reconstructive and Evans tenodesis procedures are effective in treating chronic ankle instability, with no clinically significant instability observed post-operatively.
- Evans tenodesis demonstrated a biomechanical advantage with reduced talar tilt.
- Christman/Snook procedures provide favorable outcomes for subtalar instability.
- High patient satisfaction and functional recovery were reported for all evaluated surgical techniques.