title: Reconstruction of the lateral ankle ligaments with bone-patellar tendon graft in patients with chronic ankle instability: a preliminary report.
abstract: BACKGROUND
  Unsatisfactory long-term results have been reported after use of a Broström repair for patients with chronic ankle ligament insufficiency.
  
  
  OBJECTIVE
  Repair or reconstruction of both the anterior talofibular and calcaneofibular ligaments is essential for normal kinematics of the ankle-hindfoot.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Thirteen patients with chronic instability of the ankle were found at operation to have injuries of both the anterior talofibular and calcaneofibular ligaments, with a lack of healthy ligament margins suitable for suturing. Reconstruction of the ligaments was performed with bone-patellar tendon graft. The score devised by Good et al. was used to assess the patients' clinical condition before the operation and at final follow-up.
  
  
  RESULTS
  Before the operation, six patients had a grade 3 clinical condition and seven had a grade 4 condition. At a mean follow-up of 26.5 months, all patients had a grade 1 condition. The average talar tilt of the patients was improved from 18.4 degrees +/- 5.5 degrees to 4.9 degrees +/- 2.6 degrees, and the average anterior drawer sign was improved from 9.1 +/- 2.6 mm to 5.8 +/- 1.6 mm.
  
  
  CONCLUSIONS
  In cases of combined injuries, short-term results of reconstruction of the anterior talofibular and calcaneofibular ligaments using bone-split patellar tendon graft were good, with a low frequency of complications.
authors.affiliation: Department of Orthopaedic Surgery, Saiseikai Nara Hospital, Hachijo, Nara-shi, Nara 630-8145, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takakura
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Kumai
authors.forename: Makoto
authors.initials: M
authors.lastname: Iwai
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000503:physiopathology / Q000601:surgery*; D002908:Chronic Disease / Q000628:therapy; D005260:Female; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D017847:Patellar Ligament / Q000637:transplantation*; D014184:Transplantation, Homologous; D016896:Treatment Outcome