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. 2014 Sep 22;3(5):e593-8.
doi: 10.1016/j.eats.2014.06.018. eCollection 2014 Oct.

Arthroscopic anatomic reconstruction of the lateral ligaments of the ankle with gracilis autograft

Stéphane Guillo  1 , Pooler Archbold  2 , Anthony Perera  3 , Thomas Bauer  4 , Bertrand Sonnery-Cottet  5
Affiliations

Arthroscopic anatomic reconstruction of the lateral ligaments of the ankle with gracilis autograft

Stéphane Guillo et al. Arthrosc Tech. .

Abstract

Lateral ankle sprains are common; if conservative treatment fails and chronic instability develops, stabilization surgery is indicated. Numerous surgical procedures have been described, but those that most closely reproduce normal ankle lateral ligament anatomy and kinematics have been shown to have the best outcomes. Arthroscopy is a common adjunct to open ligament surgery, but it is traditionally only used to improve the diagnosis and the management of any associated intra-articular lesions. The stabilization itself is performed open because standard anterior ankle arthroscopy provides only partial visualization of the anterior talofibular ligament from above and the calcaneofibular ligament attachments cannot be seen at all. However, lateral ankle endoscopy can provide a view of this area that is superior to open surgery. We have developed a technique of ankle endoscopy that enables anatomic positioning of the repair or fixation of the graft. In this article we describe a safe and reproducible arthroscopic anatomic reconstruction of the lateral ligaments of the ankle using a gracilis autograft. The aim of this procedure is to obtain a more physiological reconstruction while maintaining all the advantages of an arthroscopic approach.

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Figures

Fig 1
Fig 1
Landmarks and portals: anteromedial portal (portal 1), anterolateral portal (portal 2), sinus tarsi portal (portal 3), and retromalleolar tendoscopic portal (portal 4). It should be noted that portal 2 is made by transillumination.
Fig 2
Fig 2
Arthroscopic view of lateral gutter before dissection. (M, malleolus; T, lateral side of talus.)
Fig 3
Fig 3
Retromalleolar tendoscopic visualization of peroneus brevis.
Fig 4
Fig 4
Arthroscopic and endoscopic dissection of lateral hindfoot: dissection from anterolateral arthroscopy (1) and dissection by tendoscopy and lateral endoscopy (2).
Fig 5
Fig 5
Preparation of gracilis graft.
Fig 6
Fig 6
(A) Anatomic arthroscopic reconstruction with gracilis. (B) Cadaveric dissection after arthroscopic reconstruction.
See this image and copyright information in PMC

References

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