Anatomical reconstruction of the anterior inferior tibiofibular ligament for chronic disruption of the distal tibiofibular syndesmosis

Abstract

The purpose of this study was to investigate the clinical results of anatomical reconstruction of anterior inferior tibiofibular ligament (AITFL) for the chronic tibiofibular syndesmotic disruption after typical pronation external rotation (PER) stage 4 injury. Six consecutive patients with chronic syndesmotic disruption after PER stage 4 injury were surgically treated. In all six patients, preoperative CT revealed remarkable opening of only the anterior part of the distal tibiofibular joint, and all six underwent anatomical reconstruction of the AITFL using autogenous gracilis tendon after confirmation of preserved tension of the posterior inferior tibiofibular ligament through intra-operative arthroscopic examination. Clinical evaluation was made using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS)and visual analogue scale (VAS) just before reconstructive surgery and at the most recent follow-up (median: 38months, range, 31-50). Median AOFAS score improved from preoperative 53 points (range, 47-74) to postoperative 95 points (range, 90-100) (P<0.05), and median VAS score improved from preoperative 95 points (range, 55-100) to postoperative 4 points (range, 0-14) (P<0.05). The procedure, which can achieve anatomical reconstruction of the AITFL easily, seems to be one possible treatment for chronic disruption of the distal tibiofibular syndesmosis after PER stage 4 injury including avulsion fracture of the posterior malleolus, which is most common in this type of injury.