Clinical and gait-analytical results of the modified Evans tenodesis in chronic fibulotalar ligament instability.
The present paper describes the medium-term results (mean follow-up period 3.01 years) achieved after surgical stabilisation of 79 patients using modified Evans tenodesis. The follow-up examination included a questionnaire for rating the subjective sense of stability, a clinical examination, stress X-rays, a modified 100-point score according to Zwipp, and kinetic gait analysis. Although joint instability was significantly improved in the radiological stress images, only 73.4% of the patients subjectively rated the stability achieved as excellent or good, compared with satisfactory in 22%, and even poor in 3.8%. In the overall result of the 100-point score, 51.9% of the patients achieved a very good, 35.4% a good, 11.4% a satisfactory, and 1.3% a poor result. Radiologically, an increase in the rate of arthrosis was verified in 17.4%. Significant deteriorations in mobility were observed for the supination. The kinetic gait analysis revealed statistically significant differences compared with the non-operated side for step length (P < 0.05), relative step length (P < 0.05), and in the symmetry of heel-to-toe movement (P < 0.005). The modified Evans repair can restore the mechanical stability of the ankle, but it leads to impaired kinematics of the ankle, with subjective and functional restrictions and radiologically detectable degenerative changes. For this reason, modified Evans tenodesis should only be performed if anatomically orientated stabilisation operations are not possible.
Labs
K
K
University Hospital Charité, Department of Orthopaedics, Schumannstr. 20/21, 10117 Berlin, Germany. karsten.labs@charite.de
Perka
C
C
Lang
T
T
D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint; D002908:Chronic Disease; D005260:Female; D005684:Gait; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation*