The delta-snook ankle ligament reconstruction for combined deltoid insufficiency and lateral ankle instability

Abstract

BackgroundAnkle sprains are one of the most common injuries amongst the general population and affect all spectrums of activity levels. While the anterior talofibular and calcaneal fibular ligaments are most prevalently injured during sprains there are instances when chronic lateral ankle instability leads to rotational ankle instability and attenuate the deltoid ligament. The few literature that exists concerning lateral and medial ankle ligament reconstruction focus on an arthroscopic approach. AimThe goal of this current work is to describe a novel open surgical reconstruction of the lateral collateral ligaments and anterior deltoid through a coupled repair. Surgical TechniqueA singular semitendinosus allograft is utilized to reconstruct the anterior deltoid, anterior talofibular and calcaneofibular ligaments. Canals are reamed for anchoring of the allograft through the medial malleolus, anterior talar body, distal fibula, and midline calcaneus. The anterior talar body, distal fibula and midline calcaneus are reamed fully to allow for pull through technique of the allograft. The medial malleolus and talar neck are anchored first, followed by the anterior fibula, and lastly the lateral calcaneus. All anchoring is performed with the ankle in a neutral position. ConclusionThis work successfully describes a novel open surgical reconstruction of the lateral collateral ligaments and anterior deltoid through a coupled repair. This technique affords the surgeon greater control over the final product and allows for a repair in a neutral position. The semitendinosus allograft also allows for a more anatomic repair with less incidence of stiffening at the ankle joint. The authors’ have noted good results and return to full activity for the patients that have undergone this procedure.