Augmented Lateral Ankle Ligament Reconstruction for Persistent Ankle Instability


Augmented Lateral Ankle Ligament Reconstruction for Persistent Ankle Instability


Patient Selection


Indications


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Figure 1Photograph shows the anterior drawer test. The foot is slightly plantarflexed and internally rotated. The examiner’s right hand stabilizes the tibia while the left hand exerts an anterior pull.


Contraindications



Preoperative Imaging




  • Stress radiographs are no longer recommended


  • Weight-­bearing radiographs are used to determine articular space and alignment


    • Varus tibiotalar joint—May need more than just soft-­tissue reconstruction, including supramalleolar osteotomy


    • Varus heel alignment—May need lateralizing calcaneal osteotomy in addition to ligament reconstruction


    • Plantarflexed first ray—May increase varus moment of hindfoot and require dorsiflexion osteotomy during ligament reconstruction


  • MRI can identify injury to anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL)

Procedure


Room Setup/Patient Positioning


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Figure 2Photograph shows setup and patient positioning for lateral ankle ligament reconstruction. The surgical leg is elevated on a foam block. The peroneal nerve of the nonsurgical leg and all bony prominences are shielded from any pressure.


Surgical Technique






Video 86.1 Augmented Lateral Ankle Ligament Reconstruction. Nicholas A. Abidi, MD; Brian Martin, PA-­C (25 min)

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Figure 3Intraoperative photographs demonstrate steps in lateral ankle ligament reconstruction. A, A pigtailed tendon stripper is used to harvest a 4-­mm-­thick section of the peroneus longus tendon above the superior peroneal retinacu­lum. B, The natural origin of the calcaneofibular ligament (CFL) is exposed. C, A drill hole is made at the origin of the native CFL. An anterior cruciate ligament notch puncher is used to create a cephalad notch in the drill hole. This notch will create a place to slide the peroneus longus tendon graft alongside the tenodesis interference anchor. D, The peroneus longus tendon graft is captured with a No. 2 nonabsorbable suture and the tenodesis interference anchor system. E, The first limb of the peroneus longus tendon autograft is placed into the drill hole at the origin of the CFL. The anchor is screwed into the tunnel, providing an interference fit against the whipstitched tendon. F, A 4.0-­mm cannulated drill bit is drilled over a guide pin in the end of the fibula that travels from the CFL insertion to the anterior talofibular ligament (ATFL) origin. G, The two ends of the tunnel in the fibula are connected over a guide pin with a 4.0-­mm cannulated drill bit. H, A nitinol wire tendon-­passing tool is used to pass the peroneus longus tendon graft through the tunnel that was drilled in the fibula. I, The peroneus longus graft is passed through the tunnel from the insertion of the CFL to the origin of the ATFL. It is tensioned, and excursion of the tendon is confirmed by examining tensioning at the origin of the CFL.

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May 13, 2023 | Posted by in Uncategorized | Comments Off on Augmented Lateral Ankle Ligament Reconstruction for Persistent Ankle Instability

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