title: Allograft tendon reconstruction of the anterior talofibular ligament and calcaneofibular Ligament in the treatment of chronic ankle instability.
abstract: The purpose was retrospectively to investigate functional and clinical outcomes after anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) reconstruction using a single allograft.
  
  
  
  Patients with severe chronic lateral instability of the ankle underwent surgery after conservative treatment failed. Ultrasounds of the ankle were performed, and if the AFTL and CFL were completely torn without enough soft tissue for repair, the ligaments were reconstructed using allograft tendon. Outcomes were assessed by clinical examination, stress radiography, ultrasound, the American Orthopaedic Foot and Ankle Society score (AOFAS), and Karlsson Ankle Functional score (KAFS) before surgery and at final follow-up.
  
  
  
  Nineteen patients, ten men and nine women with mean age of 27.9 years (range, 19-41 years), underwent reconstruction. Mean follow-up was 30 months (range, 24-40 months). At final follow-up, all patients had returned to activity without instability, pain, or limited range of motion. On stress radiography, mean talar tilt angle decreased from 17.32° ± 3.58° before surgery to 4.16° ± 1.12° at follow-up (p < 0.001). Mean anterior drawer test (ADT) distance decreased from 9.79 ± 1.01 mm before surgery to 3.97 ± 0.99 mm at follow-up (p < 0.05). Mean AOFAS improved from 64.00 ± 18.43 to 90.32 ± 5.17 points (p < 0.001), and mean KAFS improved from 50.84 ± 16.73 to 90.89 ± 5.08 points (p < 0.001). Ultrasound showed the reconstructed ligaments maintained good continuity and excellent tension. No case of infection and immunological rejection was reported.
  
  
  
  This novel reconstruction technique takes into account the anatomical specialty of AFTL and CFL. This case series showed increased stability of the ankle in clinical and functional outcomes.
  
  
  
  The trial registration number (TRN) and date of registration: ChiCTR-ORC-17010796 , Mar 6th 2017. Retrospectively registered.
authors.affiliation: Department of Joint and Sports Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, No 60, Wuning Xi Road, Dongyang, Zhejiang, People's Republic of China.
authors.forename: Weikai
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Joint and Sports Medicine, Affiliated Dongyang Hospital of Wenzhou Medical University, No 60, Wuning Xi Road, Dongyang, Zhejiang, People's Republic of China. guohongxu12@163.com.
authors.forename: Guo Hong
authors.initials: GH
authors.lastname: Xu
mesh_terms: D000328:Adult; D064591:Allografts; D000843:Ankle Joint / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation*; D055815:Young Adult
keywords: ATFL; Anatomical reconstruction; CFL; Lateral instability of the ankle; Ultrasound