Lateral collateral ligament repair : Anatomical ligament reinsertion with augmentation using inferior extensor retinaculum flaps.

Abstract

For chronic lateral ankle instability an anatomical repair procedure of the lateral collateral ligaments (LCL) of the ankle with augmentation by an inferior extensor retinaculum (IER) flap is proposed. To treat the mechanical parts of an instable ankle involving both LCL and subtalar joint ligament damage. This technique is not suitable when the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are in a poor anatomical condition (exhaustive preoperative lesion mapping mandatory). This technique combines the reinsertion of the remnants of the lateral ligaments of the ankle, the ATFL and the CFL using anchors, with augmentation using an inferior extensor retinaculum flap fixed in atunnel by an interference screw. This flap works as an actual neoligament, providing not only reinforcement and collagen input but also peripheral stabilization of the subtalar joint by its calcaneal insertion and reinforcing the CFL stabilizing effect. Following immediate immobilization in an ankle-foot orthosis, proprioceptive physiotherapy exercises are initiated with areturn to sports depending on the type of sport. The postoperative outcomes and long-term follow-up results of this technique are discussed.