title: Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft: a new technique using an interference fit anchoring system.
abstract: BACKGROUND
  Few anatomical and minor invasive procedures have been reported for surgical reconstruction of the lateral ligaments to treat lateral instability of the ankle. Furthermore, there are no standards according to which ligaments should be reconstructed.
  
  
  OBJECTIVE
  A new technique for anatomically reconstructing the lateral ligaments of the ankle using an interference fit anchoring system and determining which ligaments need to be reconstructed according to the results of standard stress radiography of the talocrural and subtalar joints will be effective for treating lateral instability of the ankle.
  
  
  METHODS
  Case series; level of evidence, 4.
  
  
  METHODS
  Twenty-one patients with lateral instability of the ankle underwent surgery using the proposed interference fit anchoring system. Standard stress radiographs of the subtalar joint were performed, and if the talocalcaneal angle was less than 10 degrees , only the anterior talofibular ligament was reconstructed; if there was a 10 degrees or greater opening of the talocalcaneal angle, both the anterior talofibular ligament and the calcaneofibular ligament were reconstructed.
  
  
  RESULTS
  In the 17 patients who received only the anterior talofibular ligament reconstruction, the mean talar tilt angle on standard stress radiography of the talocrural joint was 14.5 degrees +/- 1.7 degrees before surgery and 2.6 degrees +/- 0.8 degrees 2 years after surgery (P < .0001). For the 4 patients who had both the anterior talofibular ligament and calcaneofibular ligament reconstructed, the mean talar tilt angle was 16.5 degrees +/- 1.5 degrees before surgery and 3.0 degrees +/- 0.5 degrees 2 years after surgery (P = .0015). The overall mean talocalcaneal angle on standard stress radiography of the subtalar joint was 11.3 degrees +/- 1.4 degrees before surgery and 3.5 degrees +/- 0.8 degrees 2 years after surgery (P = .0060).
  
  
  CONCLUSIONS
  The proposed system has several advantages, including anatomical reconstruction with normal stability and range of motion restored, the need for only a small incision during the reconstruction, and sufficient strength at the tendon graft-bone tunnel junction, in comparison with the tension strength of the lateral ligaments of the ankle.
authors.affiliation: Department of Orthopaedic Surgery, Shimane University School of Medicine, 89-1, Enya, Izumo, Shimane 693-8501, Japan. mtakao@med.shimane-u.ac.jp
authors.forename: Masato
authors.initials: M
authors.lastname: Takao
authors.forename: Kazunori
authors.initials: K
authors.lastname: Oae
authors.forename: Yuji
authors.initials: Y
authors.lastname: Uchio
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Ochi
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Yamamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007564:Japan; D017844:Lateral Ligament, Ankle / Q000033:anatomy & histology / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures; D014182:Transplantation, Autologous / Q000379:methods*