Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft.

PURPOSE: The purpose of this retrospective study was to assess the results of a novel surgical technique for the treatment of chronic lateral ankle instability using both a direct repair of the anterior talofibular ligament and a free gracilis tendon transfer to reconstruct anatomically the anterior talofibular and calcaneofibular ligaments.

METHODS: Between December 1998 and February 2002, 28 patients (29 ankles) underwent an anatomic reconstruction of the lateral ankle ligaments for chronic ankle instability. Patients returned for a clinical and radiologic follow-up evaluation at an average of 23 months following surgery (range, 12-52 months). Outcomes were assessed by comparison of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analog pain scores as well as a postoperative Karlsson score. A subjective self-assessment rating was also obtained. All patients underwent preoperative and postoperative radiographic assessment including talar tilt and anterior drawer stress radiographs.

RESULTS: Twenty-eight patients (29 ankles) (100%) returned for final evaluation. Good or excellent outcome was noted on patient subjective self-assessment, pain scores, AOFAS, and Karlsson scores at final follow-up in all patients. Ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was reduced from a mean of 13 degrees to 3 degrees (p <.0001) and the anterior drawer was reduced from a mean of 10 mm to 5 mm (p <.0001) by the lateral ankle ligamentous reconstruction.

CONCLUSION: In the present study, lateral ankle reconstruction with a direct anterior talofibular ligament repair and free gracilis tendon graft augmentation resulted in a high percentage of successful results, excellent ankle stability with a minimal loss of ankle or hindfoot motion, and marked reduction of pain at an average follow-up of almost 2 years.