THIRTY YEARS LOOKING FOR A RELIABLE TREATMENT OF THE LATERAL ANKLE JOINT LIGAMENT INJURIES

Abstract

We will present the results of our different studies from 1979 till now. Between 1979 and 1984 we tested 1120 consecutive patients with distorsion trauma by stress x-rays, taking only the anterior drawer sign. 237 patients (21, 2 %) were treated operatively because of pathological instability. The correlation: operative findings/positive anterior drawer sign was 85 %. Because of our prospective study in 19 84: arthrography versus x-ray in 52 patients we abandoned the invasive arthrography because it did not give better information about the instability of the ankle. After an investigation of 42 patients with instable ankle joints in our and in the university hospital of Kuopio treated by Evans operation in 1983 with the outcome 42% anteriorly instable, 26% pain at the insertion point at metatarsus V, we looked for a better reconstruction method.

We chose our own method, anatomical reinsertion of FTA and FC, and augmentation of FTA with half of syndesmosis anterior.20 patients, who were treated with this anatomical reconstruction technique(group A), and 20 patients, who underwent primary repair (group B), were controlled 2–4 years after operation. We reviewed 15 patients from group A and 17 from group B. Functional scores were good in both groups without significant difference and no difference in the mean talar translation between the two groups. In a second investigation -92–93 with 43 primary ligament repairs and 31 reconstructions, 89% were active athletes. The outcome after 2–4years was 2, 3% of primary repaired ankles were still painful vs. 22,6 of ankles in delayed reconstruction group. Improvement of anterior stress radiography 3,9mm of those with ligament repair and 1,5 mm of those with reconstructive procedures. This difference between these two groups was significant.

Should we operate primarily or treat the patients adequately-air cast, active rehabilitation and only persisting instability by operation with an anatomic reconstruction??