Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments using a semitendinosus tendon allograft and interference screws

The purpose of this study was to evaluate the functional and radiographic outcomes of a novel surgical technique devised to treat chronic lateral ankle instability. The technique involves direct repair of the anterior talofibular ligament and anatomic reconstructions of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) using a free semitendinosus tendon allograft and interference screws. This retrospective study involved a review of the records of 27 patients (28 ankles) with chronic lateral ankle instability treated from 2007 to 2009. VAS pain scores, AOFAS scores, Karlsson-Peterson ankle scores (24 ankles), and patient satisfaction were evaluated at median of 19 (12-26) months postoperatively. Radiographically, talar tilt angles and anterior talar translation were assessed in pre- and postoperative ankle stress views. Median patient age at surgery was 36.5 (16-57) years. Median VAS pain score decreased from 6 (3-9) to 2 (0-4) (P < 0.05), and median AOFAS score improved from 63 (41-84) to 91 (81-100) preoperatively to final follow-up (P < 0.05). Median Karlsson-Peterson score also significantly improved from 55 (32-77) to 80 (59-100) (P < 0.05), whereas talar tilt decreased from 17.8A degrees (10.0A degrees-25.5A degrees) to 6.7A degrees (0.3A degrees-13.0A degrees) and the mean anterior drawer test decreased from 10.0 mm (0.6-19.4) to 4.5 mm (0.2-8.7) (P < 0.05). Eighty-eight percent (21/24) were satisfied with surgery. No complication, such as subtalar stiffness or recurrent instability, was encountered. The described technique, which involves anatomic reconstruction of the ATFL and CFL using the semitendinosus tendon and interference screws with direct repair of the capsule, is a viable option for treating lateral ankle instability with stable tendon fixation and provides satisfactory clinical outcomes. Case-series, Level IV.