title: Reconstruction of the Lateral Ligaments of the Ankle Using a Periosteal Flap in Children and Teenagers: A Midterm Follow-up Survey.
abstract: BACKGROUND
  The rate of chronic lateral ankle instability has increased in children and teenagers. However, studies concerning its management within this population are rare. Current repair techniques involve use of the peroneus brevis tendon. Herein, we have described and evaluated a method utilizing a regional periosteal flap for reconstructing the lateral ligaments of the ankle.
  
  
  METHODS
  We conducted a single-center, retrospective study over a 4-year period. For functional assessment, we used the American Orthopedic Foot and Ankle Society (AOFAS) score as well as Gould's criteria. For radiologic assessment, we calculated the tibiotalar tilt and anterior translation of the talus.
  
  
  RESULTS
  A total of 14 children were included in this study. The mean age of patients was 12.7 years old, and the mean follow-up was 3.1 years. The mean AOFAS score evolved from 61 points (before surgery) to 95 points after surgery (P<0.001). The Gould classification revealed 11 excellent, 2 good, 1 average, and no bad outcomes. Further, surgical intervention led to evolution of the tibiotalar tilt from 14 to 4 degrees (P<0.001), whereas the anterior translation of the talus went from 11 to 2 mm (P<0.001). The mean skeletal age was 12.5 years. No case of epiphysiodesis of the lateral malleolus or heterotopic bone was found. It appears that nonanatomic reconstruction involving the peroneus brevis can be avoided in young patients. Because of the frequent impossibility of ligament suturing within this population, we have developed a reconstruction technique involving the use of a regional periosteal flap. Notably, in the case of recurrence, the patients' peroneus brevis tendons remain intact for future procedures.
  
  
  CONCLUSIONS
  Repair involving the periosteal flap yields good clinical and radiologic results. Our preliminary findings are encouraging and suggest that this technique should be evaluated in a larger patient population with long-term follow-up.
  
  
  METHODS
  Retrospective study.
authors.affiliation: Departments of †Orthopedics and Traumatology *Pediatric Surgery, Limoges University Hospital, Limoges, France.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Mathieu
authors.forename: Pierre-Sylvain
authors.initials: PS
authors.lastname: Marcheix
authors.forename: Virginie
authors.initials: V
authors.lastname: Vacquerie
authors.forename: Pierrick
authors.initials: P
authors.lastname: Dijoux
authors.forename: Christian
authors.initials: C
authors.lastname: Mabit
authors.forename: Laurent
authors.initials: L
authors.lastname: Fourcade
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000601:surgery; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D017844:Lateral Ligament, Ankle / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D008297:Male; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome