Anatomic Reconstruction With a Semitendinosus Allograft for Chronic Lateral Ankle Instability

Abstract

Background: The modified Broström procedure has been successful for most patients with chronic lateral ankle instability (CLAI); however, a subset of patients has had unsatisfactory outcomes. For those at risk of failure, anatomic reconstruction of the lateral ankle ligaments using a semitendinosus allograft to augment the modified Broström procedure is available. Purpose: To report the results of anatomic reconstruction of the lateral ankle with a semitendinosus allograft for the treatment of CLAI. Study Design: Case series; Level of evidence, 4. Methods: This is a retrospective review of a single surgeon’s experience from 2003 to 2011 in performing anatomic lateral ankle ligament reconstruction with a semitendinosus allograft for the treatment of CLAI. Of 38 patients (40 ankles), 31 (33 ankles; 82% of patients) returned for final follow-up and constituted the study group. Preoperatively, all patients completed the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AHS) and a visual analog scale (VAS) for pain and underwent plain and stress talar tilt radiographs. At the most recent follow-up, patients were evaluated by an independent surgeon and completed the postoperative AHS, Foot-Function Index (FFI), VAS for pain, Tegner activity score, and a satisfaction survey. Patients were evaluated with plain and stress talar tilt and anterior drawer radiographs. Results: At a mean follow-up of 38 ± 30 months (range, 24-107 months), 100% of patients were completely satisfied with the procedure. AHS values significantly improved from a mean of 60.3 ± 14.4 to 87.5 ± 9.3 ( P < .0001). VAS pain scores significantly decreased from 7.3 ± 1.3 to 1.9 ± 1.8 ( P < .0001). Twenty-two of 31 patients (71%) either returned to or were 1 level below their previous preoperative or preinjury Tegner activity level. No patients developed arthritic changes beyond grade I on plain radiographs. On stress radiographs, the mean talar tilt decreased from 14.3° ± 5.4° to 3.1° ± 2.4°. The mean postoperative anterior tibiotalar translation was 1.8 ± 1.1 mm, with no patients having greater than 5 mm of translation. Conclusion: Anatomic lateral ankle ligament reconstruction with a semitendinosus allograft for the treatment of CLAI leads to high patient satisfaction, decreased pain, a stable ankle without arthritic changes, and significantly improved function.