title: Combined medial and lateral anatomic ligament reconstruction for chronic rotational instability of the ankle.
abstract: BACKGROUND
  This study aimed to extend knowledge on the arthroscopic evaluation of the unstable ankle joint and the outcome of ligament reconstruction on rotational instability. In contrast to previous studies, we investigated the combined repair of lateral and medial ligaments.
  
  
  METHODS
  Ninety-six patients underwent medial and lateral ligament reconstruction between 2006 and 2008, 81 of whom, with a mean age of 31.9 (range, 14 to 44) years, completed the 12-month followup and were therefore included in this study (Table 1). Clinical, radiographic, and concomitant arthroscopic examination was performed prior to the ligament stabilization. Postoperative followup included clinical and radiographic evaluation after 3, 6, and 12 months.
  
  
  RESULTS
  Arthroscopy showed a lesion of the anterior fibulotalar ligament (AFTL),  calcaneofibular ligament (CFL), and tibiocalcanear ligament (TCL) (Deep part of deltoid ligament complex) in 67 patients. An avulsion of the proximal insertion point of the ATTL was additionally found in 14 cases. Clinical results 3 months after surgery showed a significant increase in the AOFAS-Hindfoot Score as well as a significant decrease of the Visual Analogue-Scale for pain (VAS) (p < 0.0001). This outcome persisted at the 12-month examination.
  
  
  CONCLUSIONS
  Rotational instability of the ankle joint in most cases has an injury of the lateral ligaments and a component of the deltoid, the TCL, but rarely with a combined lesion of the TCL and the anterior tibiotalar ligament (ATTL) (Superficial part of deltoid ligament complex). The combined lateral and medial ligament reconstruction with an anchor technique had a good clinical outcome with high patient satisfaction with few complications.
authors.affiliation: Sporthopaedicum Straubing, Straubing, Germany.
authors.forename: Tomas
authors.initials: T
authors.lastname: Buchhorn
authors.forename: Manuel
authors.initials: M
authors.lastname: Sabeti-Aschraf
authors.forename: Constantin E
authors.initials: CE
authors.lastname: Dlaska
authors.forename: Florian
authors.initials: F
authors.lastname: Wenzel
authors.forename: Alexandra
authors.initials: A
authors.lastname: Graf
authors.forename: Pejman
authors.initials: P
authors.lastname: Ziai
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery*; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D010808:Physical Examination; D011446:Prospective Studies; D012399:Rotation; D053441:Suture Anchors; D055815:Young Adult