title: Peroneus longus ligamentoplasty for chronic instability of the distal tibiofibular syndesmosis.
abstract: The distal tibiofibular syndesmosmotic ligament complex is important for dynamic stability and congruency of the ankle joint. Syndesmotic lesions in the ankle fracture-dislocations are well recognized and classified systematically. Chronic insufficiency of the syndesmosis leads to a lateral shift of the talus and under eversion stress permits a pathological rotation of the talus. There is also retroversion of the distal fibula representing a painful deformity. Little experience exists with surgical reconstruction of the syndesmosis. This article describes a new ligamentoplasty with a split peroneus longus tendon graft that mimics the normal anatomic conditions of the syndesmotic complex in 16 patients with symptomatic chronic syndesmotic insufficiency after pronation-external rotation and pronation abduction injuries to the ankle joint. Postoperatively, no infections or hematomas were seen. One patient had asymptomatic breakage of the syndesmosis screw; one patient had a 10 degree decrease of dorsiflexion at the ankle because of a partial anterior tibiofibular synostosis. Fifteen of 16 patients had pain relief at a mean follow-up period of 16.4 months (range, 13-29 months); all patients had relief of the chronic swelling of the ankle and the giving way. The mean Karlsson score at follow-up was 88 (range, 70-100) points. It may be concluded that peroneus longus ligamentoplasty in a preliminary series resulted in reliable ankle stability and considerable pain relief in patients with chronic syndesmotic instability.
authors.affiliation: Klinik für Unfall-und Wiederherstellungschirurgie, Universitätsklinikum C. G. Carus der Technischen Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany. rgrass@rcs.urz.tu-dresden.de
authors.forename: Rene
authors.initials: R
authors.lastname: Grass
authors.forename: Stefan
authors.initials: S
authors.lastname: Rammelt
authors.forename: Achim
authors.initials: A
authors.lastname: Biewener
authors.forename: Hans
authors.initials: H
authors.lastname: Zwipp
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000150:complications; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D007866:Leg; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D008297:Male; D012421:Rupture; D013710:Tendons / Q000601:surgery*; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome