Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 10;24(1):273.
doi: 10.1186/s12891-023-06390-1.

Allogeneic tendons in the treatment of malunited lateral malleolar avulsion fractures with chronic lateral ankle instability

Yu Zhang  1 , Xin Wang  1 , Xiaomeng Wang  1 , Jianming Cao  1 , Huijuan Wang  2 , Fengqi Zhang  3
Affiliations

Allogeneic tendons in the treatment of malunited lateral malleolar avulsion fractures with chronic lateral ankle instability

Yu Zhang et al. BMC Musculoskelet Disord. .

Abstract

Background: The aim of this study is to report our institution's experience regarding the application of allogeneic tendons for the reconstruction of malunited lateral malleolar avulsion fractures with chronic lateral ankle instability.

Methods: This retrospective study included 34 (34 ankles) patients surgically treated for malunited lateral malleolar avulsion fractures with chronic lateral ankle instability from January 2016 to December 2019. All patients underwent allogeneic tendon reconstruction. The pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores、Karlsson Ankle Functional Scores (KAFS) and visual analogue scale (VAS) scores were used to evaluate the functional recovery of the ankle joint. The final follow-up, based on radiographic assessment, including talar tilt and anterior talar translation, was performed to evaluate the stability of the postoperative ankle joints.

Results: Thirty-two patients (32 ankles) returned for final clinical and radiologic follow-up at an average of 29 (range 24-35) months and 2 patients (2 ankles) were lost to follow-up. The preoperative talus inclination angle (13.6 ± 1.9°) and anterior displacement (9.6 ± 2.8 mm) were re-examined under X-ray and found to be reduced to 3.4 ± 1.2° and 3.8 ± 1.1 mm, respectively (p＜0.01). The AOFAS scores increased from 58.5 ± 4.0 to 90.9 ± 3.8 and the Karlsson scores improved from 52.2 ± 3.6 to 89.8 ± 4.5, which was obviously better and the difference was statistically significant (P < 0.01). The VAS scores were significantly reduced from a preoperative mean of 6.8 ± 1.0 to 2.8 ± 0.9 postoperatively (p＜0.01).

Conclusion: In this population and with this follow-up, the application of allogeneic tendons to treat malunited lateral malleolar avulsion fractures combined with chronic lateral ankle instability appeared safe and effective.

Keywords: Allograft tendon; Chronic lateral ankle instability; Lateral malleolar ligament reconstruction; Lateral malleolus avulsion fracture.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Intraoperative images of the allogeneic tendon transfer procedure: (1) Make an 8 cm incision at the distal end of the lateral ankle joint and separate it layer by layer to the fracture end; (2) Remove free bone fragments; (3) Ligament contractures are seen after removal of bone fragments and cannot be repaired directly; (4) Use an allogeneic tendon and braid; (5) Drill the distal end of the fibula and the tendon is penetrated; (6) Move the tendon to drill the cuboid bone and fix it; (7) Adjust the tension of the tendon and fix it at the drill hole of the calcaneus; (8) Suture the tendon body to the anterior talofibular ligament at the insertion point of the talus and strengthen the suture with the surrounding tissue; 9.The appearance improved after the ligament and tendon are sutured
Fig. 2
Fig. 2
A 35-year-old female patient with right ankle sprain that lasted for 3 years was diagnosed with lateral instability of the right ankle and chronic lateral malleolar avulsion fracture. Preoperative stress level X-rays (A1, B1) and postoperative stress level X-rays (A2, B2)
Fig. 3
Fig. 3
Schematic drawing of the surgery method. A: The anterior half of the allogeneic tendon was fixed into the calcaneal tunnel. B: The allogeneic tendon crossed the fibula. C: The allogeneic tendon was sutured to the attachment area of the ATFL on the talus. D: The allogeneic tendon was fixed into the cuboid tunnel
See this image and copyright information in PMC

References

    1. Cain MS, Ban RJ, Chen YP, Geil MD, Goerger BM, Linens SW. Four-Week Ankle-Rehabilitation Programs in adolescent athletes with chronic ankle instability. J Athl Train. 2020 Aug;55(8):801–10. - PMC - PubMed
    1. Delahunt E, Bleakley CM, Bossard DS, Caulfield BM, Docherty CL, Doherty C, Fourchet F, Fong DT, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, Remus A, Verhagen E, Vicenzino BT, Wikstrom EA, Gribble PA. Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med. 2018 Oct;52(20):1304–10. - PubMed
    1. Gaddi D, Mosca A, Piatti M, Munegato D, Catalano M, Di Lorenzo G, Turati M, Zanchi N, Piscitelli D, Chui K, Zatti G, Bigoni M. Acute Ankle Sprain Management: an Umbrella Review of systematic reviews. Front Med (Lausanne). 2022 Jul 7;9:868474. - PMC - PubMed
    1. Dias S, Lewis TL, Alkhalfan Y, Ahluwalia R, Ray R. Current concepts in the surgical management of chronic ankle lateral ligament instability. J Orthop. 2022 Jul 19;33:87–94. - PMC - PubMed
    1. Liu SB, Li XH, Liu HW, Wang AG. Reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous fibular brevis tendon for chronic lateral ankle instability [J] China Orthop. 2022;35(02):172–7. - PubMed