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Review
. 2020 Jun;13(3):289-297.
doi: 10.1007/s12178-020-09623-1.

Hamstring Autograft for Lateral Ligament Stabilization

Karan A Patel  1 , Taylor Cabe  2 , Mark Drakos  3
Affiliations
Review

Hamstring Autograft for Lateral Ligament Stabilization

Karan A Patel et al. Curr Rev Musculoskelet Med. 2020 Jun.

Abstract

Purpose of review: This paper seeks to review the current literature and trends regarding use of hamstring autograft for lateral ankle instability.

Recent findings: Reconstruction of the lateral ankle ligaments using hamstring autograft has been found to be an effective method to treat ankle instability in terms of patient-reported outcomes and objective measures. Biomechanically, reconstruction has been shown to be stronger (load to failure) when compared with the Broström procedure. Clinical studies have demonstrated non-inferiority when compared with the Broström procedure, with one synthetic reconstruction technique demonstrating superior outcomes. Reconstruction of the lateral ankle ligaments using hamstring autograft is especially useful in patients who are at high risk of failure (insufficient soft tissue available for repair, ligamentous laxity, previous failed ligament repair, ossicle > 1 cm, or in the heavier, high-demand athletes).

Keywords: Broström procedure; Hamstring autograft; Lateral ankle instability.

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Conflict of interest statement

Karan A. Patel and Taylor Cabe declare that they have no conflict of interest. Mark C. Drakos declares that he is a paid consultant for Fast Form, Extremity Medical, and Pitusan 360.

Figures

Fig. 1
Fig. 1
Preoperative radiographs including anteroposterior (a) and lateral (b) stress images showing talar tilt of 20.8° and anterior drawer of 10.0 mm as well as standard, standing anteroposterior (c) and oblique (d) views. Increased talar tilt and anterior drawer on stress radiographs indicate for operative treatment via lateral ligament reconstruction
Fig. 2
Fig. 2
Sites of fibular and calcaneal incisions marked and indicated by arrows. An approximately 1-cm incision is made at the lateral aspect of the calcaneus, below the peroneal tendons and an approximately 5-cm curvilinear incision is made at the distal fibula
Fig. 3
Fig. 3
Passing sutures are in place and will be used to shuttle the hamstring autograft through each of the bone tunnels
Fig. 4
Fig. 4
The graft has been pulled out of the medial aspect of the talus after being initially secured in the calcaneal bone tunnel and then passed, first, underneath the peroneal tendons, and then underneath the ATFL
Fig. 5
Fig. 5
Postoperative anteroposterior stress radiograph (a) indicating a decreased talar tilt of 5.4° and postoperative lateral stress radiograph (b) indicating a decreased anterior drawer of 7.2 mm
Fig. 6
Fig. 6
Postoperative anteroposterior (a), oblique (b), and lateral (c) weight-bearing radiographs show the 3 bone tunnels created in the fibula, calcaneus, and talus. Arrows indicate the sites of the bone tunnels. The fibular tunnel is seen on the anteroposterior and oblique views. Calcaneal and talar tunnels are seen on the lateral view
See this image and copyright information in PMC

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