The ankle and subtalar joints form a coupling which acts like a universal joint. When the anterior talofibular ligament is disrupted, rotation of the talus about the long axis of the leg is permitted. This abnormal rotation in the transverse plane is the distinguishing feature of rotary ankle instability. The pathomechanics of rotary ankle instability are described. A simple and direct approach to repairing and reinforcing the anterior talofibular ligament and the results of 37 consecutive delayed reconstructions by this method are reported. Advantages of this procedure are felt to be a restoration of the original anatomy, preservation of the peroneal tendons, maintenance of the integrity of the subtalar joint and excellent postoperative results. Disadvantages include a lack of objective diagnostic criteria.
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References
1.
BroströmL.: Sprained Ankles. VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir. Scand., 132: 551–565, 1966.
2.
CastaingJ.Le ChevallierP.L.: Entorse a repitition ou recidivante de la tibio-tarsienne. Une technique simple de liga-mentoplastie externe. Rev. Chir. Orthop., 47: 598–608, 1961.
3.
ChrismanO.D.SnookG.A.: Reconstruction of lateral ligament tears of the ankle. An experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure. J. Bone Joint Surg. 51-A: 904–912, 1969.
4.
DouglasD.M.: Healing of aponeurotic incisions. Br. J. Surg., 40: 79–84, 1952.
5.
DuquennoyA.LetendardJ.LoockP.: Chronic instability of the ankle treated by reefing of the lateral ligament. Rev. Chir. Orthop., 66: 311–316, 1980.
6.
ElmslieR.C.: Recurrent, subluxation of the ankle-joint. Ann. Surg., 100: 364–367, 1934.
7.
EvansD.L.: Recurrent instability of the ankle. A method of surgical treatment. Proc. Royal Soc. Med., 46: 343–344, 1953.
GoodC.J.JonesM.A.LingstoneB.N.: Reconstruction of the lateral ligament of the ankle. Injury, 7: 63–65, 1975.
10.
GschwendN.: Die fibularen Bandläsionen. Eine häufig verkannte Folge der Fussverstauchungen. Praxis, 47: 809–813, 1958.
11.
HabekostH.J.MeederP.J.HolzU.: Experiences with a modified Watson-Jones method in fibular ligament instability in the upper ankle joint. Hefte Unfallheilkd., 133: 194–199, 1978.
12.
HaigH.: Repair of ligaments in recurrent subluxation of the ankle joint. J. Bone Joint Surg., 32-B:751, 1950.
13.
HambleyE.: Recurrent dislocation of the ankle due to rupture of the external lateral ligament. Br. Med. J., 1:413, 1945.
14.
HendelD.PeerA.HalperinN.: A simple operation for the correction of chronic lateral instability of the ankle. Injury, 15: 115–116, 1983.
InmanV.T.: The Joints of the Ankle. Baltimore, Williams and Wilkins, 1976.
17.
JenkinsH.R.McKibbinB.: The role of flexible carbon fibre implants as tendon and ligament substitutes in clinical practice. J. Bone Joint Surg., 62-B:497–499, 1980.
18.
KiaerS.: Bristning af fodleddets udvendige sideligamenter behandlet med tenodese. Ugeskr. Laeg., 110: 373–375, 1948.
19.
KrügerH.: Collateral ligament replacement in the upper ankle joint using the patellar ligament. Further use of Bruckner's method. Zentrabl. chir., 104: 666–672, 1979.
20.
LanhamR.H.Jr.: The Evans' ankle stabilization. The author's modification. J. Am. Podiatry Assoc., 71: 639–642, 1981.
21.
LeachR.E.: Secondary reconstruction of the lateral ligaments of the ankle. Clin. Orthop., 160: 201–211, 1981.
22.
LeeH.G.: Surgical repair in recurrent dislocation of the ankle joint. J. Bone Joint Surg., 39-A:828–834, 1957.
23.
LoustauC.: Should the lateral peroneus brevis muscle be used for external ligamentoplasties of the ankle?Ann. Chir., 37: 671–675, 1983.
24.
LuchtU.: Lateral ligament reconstruction of the ankle with a modified Watson-Jones operation. Acta Orthop. Scand., 52: 363–366, 1981.
25.
MöorlF.SanderE.: On the surgical treatment of old lacerations of the ligaments of the ankle joint. Zentrabl. Chir., 90: 760–762, 1965.
26.
NilsonneH.: Making a new ligament in ankle sprains. J. Bone Joint Surg., 14: 380–381, 1932.
27.
O'PhelanH.E.: personal communication.
28.
OttosonL.: Lateral instability of the ankle treated by a modified Evans procedure. Acta Orthop. Scand., 49: 302–305, 1978.
29.
PieronA.P.: Dynamic peroneus tendon transfer for repair of the unstable ankle. Can. J. Surg., 25: 672–675, 1982.
Rosendahl-JensenS.: Behandlingen av laterale ligamentrupturer i fodleddet. Nord. Med., 47: 903–904, 1952.
32.
St. PierreR.AllmanF.Jr.BassettF.H.IIIFlemingL.L.GoldnerJ.L.: A review of lateral ligamentous reconstructions. Foot Ankle3: 114–123, 1982.
33.
SeftonG.K.: Reconstruction of the Anterior Talofibular Ligament for the Treatment of the Unstable Ankle. J. Bone Joint Surg., 61-B:352–354, 1979.
34.
SmithG.H.GreenA.L.: Modification of the Lee lateral ankle stabilization. J. Am. Podiatry Assoc., 73: 293–296, 1983.
35.
SolheimL.F.DenstadT.F.RoaasA.: Chronic lateral instability of the ankle. A method of reconstruction using the achilles tendon. Acta Orthop. Scand., 51: 193–196, 1980.
36.
StöhrC.HubertyR.: Reconstruction of old ruptures of the lateral ligaments of the ankle using a periostal flap. Unfallheilkunde, 83: 467–471, 1980.
37.
StörenH.: A new method for operative treatment of insufficiency of the lateral ligaments of the ankle joint. Acta Chir. Scand., 117: 501–509, 1959.
38.
VidalJ.: External instability of the ankle. Importance of the subastragalar joint: new repair technique. Rev. Chir. Orthop., 60: 635–642, 1974.
39.
ViersteinK.RosemeyerB.ArtmannM.: A method of operative treatment of chronic instability of the ankle joint. Arch. Orthop. Unfallchir., 78: 157–159, 1974.
40.
Watson-JonesR.: Recurrent forward dislocation of the ankle joint. J. Bone Joint Surg., 34-B:519, 1952.
41.
Watson-JonesR.: Fractures and other bone and joint injuries. Edingburgh, E. & S. Livingstone, Ltd., 1940.
42.
WindfeldP.: Treatment of undue mobility of the ankle joint following severe sprain of the ankle with avulsion of the anterior and middle bands of the external ligament. Acta Chir. Scand., 105: 299–304, 1953.
43.
WrightD. G.DesaiM.E.HendersonW.H.: Action of the subtalar and ankle-joint complex during the stance phase of walking. J. Bone Joint Surg., 46-A:361–382, 1964.
