Reconstruction of the lateral ankle ligaments

Abstract

The purpose of this study was to perform a biome chanical analysis of several commonly performed op erative procedures used to stabilize the lateral ankle. We performed the Evans, Watson-Jones, and Chris man-Snook procedures on 15 cadaveric ankles and tested the ankles for stability, motion, and isometry of graft placement. The Evans procedure allowed in creased anterior displacement, internal rotation, and tilt of the talus when compared to ankles with intact liga ments. Subtalar joint motion was restricted by the Evans procedure. The Watson-Jones procedure con trolled internal rotation and anterior displacement of the talus, but was less effective in controlling talar tilt and also restricted subtalar joint motion. The Chrisman- Snook procedure allowed increased internal rotation and anterior displacement of the talus when compared to ankles with intact ligaments. The procedure was effective in limiting talar tilt, but restricted subtalar joint motion. Based on the biomechanical data obtained, we de vised a lateral ankle reconstruction with bone tunnels that reproduce the anatomic orientation of both the anterior talofibular and calcaneofibular ligaments. This ankle ligament reconstruction resists anterior displace ment, internal rotation, and talar tilt without restricting subtalar joint motion. Clinical relevance: We found considerable mechanical differences among the more commonly performed lat eral ankle reconstructions. It is possible to locate bone tunnels and graft placement so that a more anatomic configuration is achieved.