MIDDLE- TERM RESULTS OF AN ORIGINAL PROCEDURE OF LIGAMENTOPLASTY FOR CHRONIC LATERAL INSTABILITY OF THE ANKLE

Abstract

INTRODUCTION: The authors present the results of a surgical technique for lateral ankle chronic instability, derived from Castaing and Duquennoy procedures. It uses a half peroneus brevis with a tightening of the antero- lateral capsule. A Plasty with the extensorum digitorum brevis was used in the event of associated subtalar instability.

MATERIAL AND METHODS: Between 2001 and 2005, 38 cases of ligamentoplasties have been performed for chronic instability of the ankle. 32 (25 men and 7 women) of them have been reviewed with a mean delay of 26 months (extremes of 10 months to 5 years). They were middle-aged of 28,5 years. All the patients have been reviewed with stress X-Ray in varus of the both ankles (measure of tibio talar angle, arthritis) and had a strength measure in eversion by the same examiner. The functional evaluation was performed with Molander and Olerud ankle score.

RESULTS: There were 20% of complications, especially cutaneous cicatrisation problems and algodystrophy. After surgery, no patient had instability; only one, had apprehension of the ankle. 90 % retrieved the same sport with the same level. No body changed of job. 3 patients were disappointed because of pain in sports and stiffness. At revision, the functional score was 90 against 59 at the pre operative time. The difference of strength in eversion between the two ankles was about 7%. Laxity had a good correction seeing the average tibio talar angle between the both ankle is 0,5°.

DISCUSSION: The results of this procedure show a distinct improvement of stability, radiological laxity and functional activity. The arthrotomy performed in Duquennoy procedure, is useful for diagnosis and treatment. It shows the cartilage and allows the removal of impingement and foreign bodies. A plasty that uses the single evertor deprives the ankle of a part of active and proprioceptive control. However, the patients didn’t feel a difference or a discomfort. The patients who had the surgery on the jump foot side had no significative difference of strength in eversion between the both ankles.

CONCLUSION: This anatomical procedure gives 91% of satisfaction, for these active young people. The postoperative physiotherapy allows the complete recovery of activities from the sixth month after surgery.