Anatomical Lateral and Medial Ligament Reconstruction in Rotational Chronic Ankle Instability

Abstract

Introduction: Rotational (combined lateral and medial) chronic ankle instability (CAI) can present with pain and tenderness over the ankle joint, and can be associated with feeling of giving way and repetitive sprains. Few studies are available which examined rotational CAI clinical outcomes. Materials and methods: A retrospective reviewof prospectively assessed data of 101 cases with preoperative diagnosis ofCAI treated surgically in our institution between 2007 and 2012was performed. Only 19 cases (average age 37.3 years, range 16-64; right sided: 12 (63.2%); left sided: 7 (36.8%); follow-up range: 6-21 months); were selected after exclusion of patients with: hindfoot malalignment (varus < 0degree, valgus > 10degree), osteochondral lesion of the talus, tibialis posterior dysfunction, history of prior ankle joint surgery. Ankle joint arthroscopy followed by anatomic medial and lateral ligamentous repair were performed for all but one case. One case had an autograft for lateral ligament reconstruction. All cases underwent a standardized physiotherapy protocol and were followed a minimum of six months postoperatively. Results: 18 patients (94.7%) had pain-free range of motion and stable ankle on follow-up. One case (5.3%), a 42 years old woman, had persistent feeling of recurrent lateral ankle instability that could be due to missed osteochondral talar lesion. 18 patients (94.7%) returned to their full-time work within three months, and one patient (5.3%) was back to work after six months. Conclusion: Anatomical lateral and medial ligament reconstruction of rotationally chronic unstable ankle, with normal hindfoot alignment, is a safe surgical treatment and may yield a favourable outcome.