Anatomical reconstruction of anterior talofibular ligament by partial peroneal brevis tendon combined with double intra-fix screws_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhenyu ¹ , ZHENG Guo ¹ , ZHENG Xiaolong ² , XIE Xingyu ¹ ,  TAO Xu ¹ ,  TANG Kanglai ¹

1. Sports Medicine Center, the First Affiliated Hospital of Army Medical University, Chongqing, 400038, P.R.China;
2. Unit 95979 of People’s Liberation Army of China, Xintai Shandong, 271000, P.R.China;

Corresponding?author：

TAO Xu, Email: taoux@hotmail.com; TANG Kanglai, Email: tangkanglai@hotmail.com

Keywords：

Anterior talofibular ligament; peroneal brevis tendon; anatomical reconstruction; minimally invasive

DOI：

10.7507/1002-1892.202007131

Video：

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Objective To investigate the effectiveness of anatomical reconstruction of the anterior talofibular ligament by partial peroneal brevis tendon combined with double intra-fix screws.Methods A clinical data of 46 patients with the anterior talofibular ligament rupture admitted between September 2015 and October 2019 and met the selection criteria were retrospectively analyzed. All anterior talofibular ligaments were reconstructed with partial peroneal brevis tendon and fixed with double intra-fix screws. There were 22 males and 24 females, with an average age of 28.1 years (range, 16-52 years). Forty cases had a history of ankle sprain, 1 case was injured by a heavy object, and 5 cases were suffered from falls. There were 17 cases on the left side and 29 cases on the right side. The disease duration ranged from 3 months to 10 years (median, 20.3 months). The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, varus angle of ankle, and the difference of the anterior talar translation between healthy and affected sides (looseness, similarity, tightness) were recorded before and after operation; 23 patients were evaluated by Patient-Reported Outcomes Measurement Information System (PROMIS) score, including pain interference (PI) and physical function (PF) scores.Results The operation time was 39-179 minutes, with an average of 65.8 minutes. All incisions healed by first intention. All patients were followed up 12-30 months (mean, 23 months). The VAS score, AOFAS ankle-hindfoot score, varus angle of ankle, difference of the anterior talar translation between healthy and affected sides, and PI and PF scores of PROMIS at 6 months and last follow-up significantly improved when compared with those before operation (P<0.05). There was no significant difference in VAS score, PI score of PROMIS, and AOFAS ankle-hindfoot score between at 6 months and at last follow-up (P>0.05). However, the PF score of PROMIS, the difference of the anterior talar translation between healthy and affected sides, and the varus angle of ankle were significant (P<0.05).Conclusion Anatomical reconstruction of the anterior talofibular ligament by partial peroneal brevis tendon and double intra-fix screws has the advantages of small incision, convenient tendon removal, and firm graft fixation. The postoperative patients recover quickly and the effectiveness is satisfactory.

Citation： WANG Zhenyu, ZHENG Guo, ZHENG Xiaolong, XIE Xingyu, TAO Xu, TANG Kanglai. Anatomical reconstruction of anterior talofibular ligament by partial peroneal brevis tendon combined with double intra-fix screws. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(1): 70-75. doi: 10.7507/1002-1892.202007131 Copy

1.	Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med, 2007, 37(1): 73-94.
2.	van Rijn RM, van Os AG, Bernsen RM, et al. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med, 2008, 121(4): 324-331.
3.	唐康來. 注重慢性踝關節不穩的診斷和治療. 中國骨傷, 2012, 25(8): 623-626.
4.	Ng ZD, Das De S. Modified Brostrom-Evans-Gould technique for recurrent lateral ankle ligament instability. J Orthop Surg (Hong Kong), 2007, 15(3): 306-310.
5.	周一飛, 盧曉郎, 賴紅燕, 等. Evans 和 Chrisman-Snook 術式治療踝關節外側副韌帶Ⅱ度損傷的生物力學比較. 中國骨傷, 2012, 25(8): 654-657.
6.	張宇, 王勇, 張文舉, 等. 全鏡下無結錨釘技術修復距腓前韌帶治療慢性踝關節外側不穩. 中華骨科雜志, 2019, 39(9): 525-531.
7.	Colville MR, Grondel RJ. Anatomic reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft. Am J Sports Med, 1995, 23(2): 210-213.
8.	施忠民, 陳城, 馬燕紅, 等. 中國慢性踝關節外側不穩定術后康復專家共識. 中華骨與關節外科雜志, 2019, 12(10): 747-753.
9.	Pearce CJ, Tourné Y, Zellers J, et al. Rehabilitation after anatomical ankle ligament repair or reconstruction. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1130-1139.
10.	Camacho LD, Roward ZT, Deng Y, et al. Surgical management of lateral ankle instability in athletes. J Athl Train, 2019, 54(6): 639-649.
11.	Adachi N, Fukuhara K, Kobayashi T, et al. Morphologic variations of the fibular malleolar groove with recurrent dislocation of the peroneal tendons. Foot Ankle Int, 2009, 30(6): 540-544.
12.	茅宇侖, 周強, 張平超. 自體與異體肌腱微創移植重建踝關節外側韌帶的對比研究. 實用臨床醫藥雜志, 2014, 18(17): 59-62.
13.	Li Q, Ma K, Tao H, et al. Clinical and magnetic resonance imaging assessment of anatomical lateral ankle ligament reconstruction: comparison of tendon allograft and autograft. Int Orthop, 2018, 42(3): 551-557.
14.	Eriksson K, Larsson H, Wredmark T, et al. Semitendinosus tendon regeneration after harvesting for ACL reconstruction. A prospective MRI study. Knee Surg Sports Traumatol Arthrosc, 1999, 7(4): 220-225.
15.	Tadokoro K, Matsui N, Yagi M, et al. Evaluation of hamstring strength and tendon regrowth after harvesting for anterior cruciate ligament reconstruction. Am J Sports Med, 2004, 32(7): 1644-1650.
16.	劉彩龍, 趙金忠. 腘繩肌腱取材后再生的研究. 中華骨科雜志, 2008, 28(5): 420-423.
17.	朱淵, 徐向陽, 劉津浩, 等. 踝關節本體感受器損傷與慢性踝關節不穩定關系的初步研究. 中華創傷雜志, 2011, 27(5): 446-450.

1. Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med, 2007, 37(1): 73-94.
2. van Rijn RM, van Os AG, Bernsen RM, et al. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med, 2008, 121(4): 324-331.
3. 唐康來. 注重慢性踝關節不穩的診斷和治療. 中國骨傷, 2012, 25(8): 623-626.
4. Ng ZD, Das De S. Modified Brostrom-Evans-Gould technique for recurrent lateral ankle ligament instability. J Orthop Surg (Hong Kong), 2007, 15(3): 306-310.
5. 周一飛, 盧曉郎, 賴紅燕, 等. Evans 和 Chrisman-Snook 術式治療踝關節外側副韌帶Ⅱ度損傷的生物力學比較. 中國骨傷, 2012, 25(8): 654-657.
6. 張宇, 王勇, 張文舉, 等. 全鏡下無結錨釘技術修復距腓前韌帶治療慢性踝關節外側不穩. 中華骨科雜志, 2019, 39(9): 525-531.
7. Colville MR, Grondel RJ. Anatomic reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft. Am J Sports Med, 1995, 23(2): 210-213.
8. 施忠民, 陳城, 馬燕紅, 等. 中國慢性踝關節外側不穩定術后康復專家共識. 中華骨與關節外科雜志, 2019, 12(10): 747-753.
9. Pearce CJ, Tourné Y, Zellers J, et al. Rehabilitation after anatomical ankle ligament repair or reconstruction. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1130-1139.
10. Camacho LD, Roward ZT, Deng Y, et al. Surgical management of lateral ankle instability in athletes. J Athl Train, 2019, 54(6): 639-649.
11. Adachi N, Fukuhara K, Kobayashi T, et al. Morphologic variations of the fibular malleolar groove with recurrent dislocation of the peroneal tendons. Foot Ankle Int, 2009, 30(6): 540-544.
12. 茅宇侖, 周強, 張平超. 自體與異體肌腱微創移植重建踝關節外側韌帶的對比研究. 實用臨床醫藥雜志, 2014, 18(17): 59-62.
13. Li Q, Ma K, Tao H, et al. Clinical and magnetic resonance imaging assessment of anatomical lateral ankle ligament reconstruction: comparison of tendon allograft and autograft. Int Orthop, 2018, 42(3): 551-557.
14. Eriksson K, Larsson H, Wredmark T, et al. Semitendinosus tendon regeneration after harvesting for ACL reconstruction. A prospective MRI study. Knee Surg Sports Traumatol Arthrosc, 1999, 7(4): 220-225.
15. Tadokoro K, Matsui N, Yagi M, et al. Evaluation of hamstring strength and tendon regrowth after harvesting for anterior cruciate ligament reconstruction. Am J Sports Med, 2004, 32(7): 1644-1650.
16. 劉彩龍, 趙金忠. 腘繩肌腱取材后再生的研究. 中華骨科雜志, 2008, 28(5): 420-423.
17. 朱淵, 徐向陽, 劉津浩, 等. 踝關節本體感受器損傷與慢性踝關節不穩定關系的初步研究. 中華創傷雜志, 2011, 27(5): 446-450.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomical reconstruction of anterior talofibular ligament by partial peroneal brevis tendon combined with double intra-fix screws

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