Anatomic reconstruction of the lateral ligaments of the ankle using a plantaris tendon graft [Anatomische rekonstruktion der lateralen sprunggelenkbander mit der plantarissehne zur behandlung der chronischen instabilitat]

The purpose of this work was to present our technique of anatomic reconstruction of the lateral ankle ligaments using a free plantaris tendon graft. Between 1988 and 1997, 52 ankles (48 patients) were treated for chronic ankle instability resisting to a training program of minimally 3 months. The average age was 28.6 years (16 to 46 years) at the time of surgery. There were 30 ankles in men and 22 ankles in females. 4 patients were treated on both ankles. 50 ankles were available for a follow-up investigation after a mean of 3.5 years (1 to 10 years). Based on the AOFAS- Hindfoot-Scale an average score of 97.9 points (90 to 100 points) was found. The functional result was found to be excellent in 39 ankles (78%), good in 9 ankles (18%), fair in 2 ankles (4%), and poor in 0 ankle (0%). Dorsi- /plantarflexion was not restricted in any ankle. Supination was slightly restricted in 2 ankles, but not increased in any ankle. High patient's satisfaction with respect to the achieved stability was found in all but one ankle. No deterioration with time was observed in any case. The overall good and excellent results with this method may be explained by the strictly anatomic reconstruction that did not alter the kinematics nor the mechanics of the ankle joint complex. In addition the peroneal tendons were not weakened. We feel that this procedure is a better alternative to other more complex ligament reconstructions, especially tenodesis operations by using the peroneal tendon.