title: Anatomic lateral ligament reconstruction in the ankle: a hybrid technique in the athletic population.
abstract: BACKGROUND
  Anatomic and checkrein tenodesis reconstruction techniques have been described as a means of treatment for chronic lateral ligament instability in the ankle. The current article describes a hybrid procedure using the most advantageous concepts of both techniques for use when insufficient normal ligament remains to fashion a direct repair of the anterior talofibular ligament (ATFL).
  
  
  OBJECTIVE
  The authors report the results at a minimum 1-year follow-up of 57 patients who underwent a hybrid anatomic lateral ligament reconstruction technique in the ankle.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Fifty-seven patients underwent a hybrid anatomic lateral ligament reconstruction procedure under the care of the senior author. All patients were assessed preoperatively and postoperatively using the Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) outcome score. The mean patient age at the time of surgery was 28 years (range, 17-65 years), including 39 male and 18 female patients. The mean follow-up time was 32 months (range, 12-47 months).
  
  
  RESULTS
  The FAOS improved from 58 points preoperatively to 89 points postoperatively (P < .01). The SF-12 score improved from 48 points before surgery to 80 points at final follow-up (P < .01). All patients achieved mechanical stability at final clinical follow-up; 7 patients (12%) demonstrated functional instability. Functional instability was found to significantly influence not returning to sport at the previous level.
  
  
  CONCLUSIONS
  This hybrid anatomic lateral ligament reconstruction technique using a peroneus longus autograft to substitute the native ATFL provides an alternative to anatomic reconstruction when direct repair is not possible.
authors.affiliation: Hospital for Special Surgery, 523 East 72nd Street, Suite 514, New York, NY 10021, USA. kennedyj@hss.edu
authors.forename: John G
authors.initials: JG
authors.lastname: Kennedy
authors.forename: Niall A
authors.initials: NA
authors.lastname: Smyth
authors.forename: Ashraf M
authors.initials: AM
authors.lastname: Fansa
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Murawski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery; D001265:Athletic Injuries / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D053656:Tenodesis; D019737:Transplants; D055815:Young Adult