Reconstruction of the Lateral Ankle Ligament With a Long Extensor Tendon Graft of the Fourth Toe

Abstract

Background: The treatment of lateral ankle instability is challenging when the remaining ligamentous tissue is insufficient. Anatomic reconstruction with a tendon graft is a good option that can produce a stable ankle and avoid the complications of a nonanatomic tenodesis procedure. Hypothesis: A new technique for anatomically reconstructing the lateral ligaments of the ankle using an extensor digitorum longus tendon graft of the fourth toe will be effective for treating lateral ankle instability with chronic ligamentous insufficiency. Study Design: Case series; Level of evidence, 4. Methods: Twenty-four patients were treated with anatomic reconstruction of the ligaments using the long extensor tendon of the fourth toe. The mean age was 35.7 years (range, 16-53 years). The minimum follow-up was 24 months (range, 24-57 months; mean, 37 months). There were 17 cases of chronic ligamentous insufficiency, 3 failed Brostrom operations, and 4 others. Preoperative and postoperative Karlsson scales were used to analyze the functional results. The anterior displacement and the talar tilt angle on standard stress radiography of the talocrural joint were measured preoperatively and at the time of last follow-up for comparison. Results: The results on the Karlsson scale increased from 48.0 ± 4.2 points preoperatively to 92.2 ± 3.8 points at the latest follow-up ( P < .01). Radiographically, the mean anterior displacement was 6.7 ± 1.2 mm before operation and 3.4 ± 0.6 mm at the latest follow-up ( P < .01). The mean talar tilt angle was 12.3° ± 1.1° before the operation and 4.3° ± 0.8° at the latest follow-up ( P < .01). Conclusion: Anatomic reconstruction of the lateral ankle ligaments using the long extensor tendon of the fourth toe appears to be an effective surgical option for chronic insufficiency of the lateral ankle ligament.