title: Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft.
abstract: OBJECTIVE
  The purpose of this retrospective study was to assess the results of a novel surgical technique for the treatment of chronic lateral ankle instability using both a direct repair of the anterior talofibular ligament and a free gracilis tendon transfer to reconstruct anatomically the anterior talofibular and calcaneofibular ligaments.
  
  
  METHODS
  Between December 1998 and February 2002, 28 patients (29 ankles) underwent an anatomic reconstruction of the lateral ankle ligaments for chronic ankle instability. Patients returned for a clinical and radiologic follow-up evaluation at an average of 23 months following surgery (range, 12-52 months). Outcomes were assessed by comparison of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analog pain scores as well as a postoperative Karlsson score. A subjective self-assessment rating was also obtained. All patients underwent preoperative and postoperative radiographic assessment including talar tilt and anterior drawer stress radiographs.
  
  
  RESULTS
  Twenty-eight patients (29 ankles) (100%) returned for final evaluation. Good or excellent outcome was noted on patient subjective self-assessment, pain scores, AOFAS, and Karlsson scores at final follow-up in all patients. Ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was reduced from a mean of 13 degrees to 3 degrees (p <.0001) and the anterior drawer was reduced from a mean of 10 mm to 5 mm (p <.0001) by the lateral ankle ligamentous reconstruction.
  
  
  CONCLUSIONS
  In the present study, lateral ankle reconstruction with a direct anterior talofibular ligament repair and free gracilis tendon graft augmentation resulted in a high percentage of successful results, excellent ankle stability with a minimal loss of ankle or hindfoot motion, and marked reduction of pain at an average follow-up of almost 2 years.
authors.affiliation: Idaho Foot and Ankle Fellowship Program, 901 N. Curtis Road, Ste. #503, Boise, ID 83706, USA. footmd@aol.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Coughlin
authors.forename: Robert C
authors.initials: RC
authors.lastname: Schenck
authors.forename: Brett R
authors.initials: BR
authors.lastname: Grebing
authors.forename: Gehron
authors.initials: G
authors.lastname: Treme
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013709:Tendon Transfer