Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a multicenter study.
The long-term clinical outcome after anatomical reconstruction and tenodesis in the treatment of chronic anterolateral ankle instability was assessed in a retrospective multicentre study. The first group (AR) consisted of 25 patients (mean age at operation 22 yrs +/- 5.7) who underwent anatomical reconstruction and the second group (TE) of 29 patients (mean age 23 yrs +/- 6.6) who underwent tenodesis. For both groups, the mean follow-up period was 12.3 yrs (AR +/- 2.5 yrs, TE +/- 2.7 yrs). At physical examination, there were significantly more patients in the TE group (n=18) with a positive anterior drawer sign as compared with the AR group (n=7) (p=0.02). Medially located degenerative changes in the ankle joint as seen on standard radiographs were seen more often in the TE group (n=7) than in the AR group (n=1) (p=0.03). The mean talar tilt, 4.7 degrees in the AR group vs 6.9 degrees in the TE group, (p=0.02) and anterior talar translation, 2.9 mm in the AR group vs 4.3 mm in the TE group, (p=0.04) were significantly higher in the TE group at radiographic stress examination. According to the rating system developed by Good et al. (1975), significantly fewer patients in the TE group (n=8) had an excellent result as compared with the AR group (n=15) (p=0.03) and more patients in the TE group (n=9) had a fair or poor result (p=0.04) as compared with the AR group (n=2). We conclude that a tenodesis procedure does not restore the normal anatomy of the lateral ankle ligaments. When compared with anatomical reconstruction, a tenodesis leads to inferior results in terms of functional and mechanical stability, as well as overall satisfaction at long-term follow-up.
Krips
R
R
Academic Medical Center, Amsterdam, The Netherlands.
van Dijk
C N
CN
Halasi
P T
PT
Lehtonen
H
H
Corradini
C
C
Moyen
B
B
Karlsson
J
J
D000328:Adult; D000842:Ankle; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013524:Surgical Flaps; D013710:Tendons / Q000601:surgery*