Augmented Ligament Reconstruction Partially Restores Hindfoot and Midfoot Kinematics After Lateral Ligament Ruptures

Abstract

Background: Altered kinematics and persisting ankle instability have been associated with degenerative changes and osteo-chondral lesions. Purpose: To study the effect of ligament reconstruction surgery with suture tape augmentation (isolated anterior talofibular lig-ament [ATFL] vs combined ATFL and calcaneofibular ligament [CFL]) after lateral ligament ruptures (combined ATFL and CFL) onfoot-ankle kinematics during simulated gait.
Study Design: Controlled laboratory study.
Methods: Five fresh-frozen cadaveric specimens were tested in a custom-built gait simulator in 5 different conditions: intact, ATFLrupture, ATFL-CFL rupture, ATFL-CFL reconstruction, and ATFL reconstruction. For each condition, range of motion (ROM) and theaverage angle (AA) in the hindfoot and midfoot joints were calculated during the stance phase of normal and inverted gait.
Results: Ligament ruptures mainly changed ROM in the hindfoot and the AA in the hindfoot and midfoot and influenced the kine-matics in all 3 movement directions. Combined ligament reconstruction was able to restore ROM in inversion-eversion in 4 of the5 joints and ROM in internal-external rotation and dorsiflexion-plantarflexion in 3 of the 5 joints. It was also able to restore the AAin inversion-eversion in 2 of the 5 joints, the AA in internal-external rotation in all joints, and the AA in dorsiflexion-plantarflexion in1 of the joints. Isolated ATFL reconstruction was able to restore ROM in inversion-eversion and internal-external rotation in 3 ofthe 5 joints and ROM in dorsiflexion-plantarflexion in 2 of the 5 joints. Isolated reconstruction was also able to restore the AA ininversion-eversion and dorsiflexion-plantarflexion in 2 of the joints and the AA in internal-external rotation in 3 of the joints. Bothisolated reconstruction and combined reconstruction were most successful in restoring motion in the tibiocalcaneal and talona-vicular joints and least successful in restoring motion in the talocalcaneal joint. However, combined reconstruction was still betterat restoring motion in the talocalcaneal joint than isolated reconstruction (13 for ROM and 13 for the AA with isolated reconstruc-tion compared to 13 for ROM and 23 for the AA with combined reconstruction).
Conclusion: Combined ATFL-CFL reconstruction showed better restored motion immediately after surgery than isolated ATFLreconstruction after a combined ATFL-CFL rupture.
Clinical Relevance: This study shows that ligament reconstruction with suture tape augmentation is able to partially restore kine-matics in the hindfoot and midfoot at the time of surgery. In clinical applications, where the classic Brostro ̈m-Gould technique isfollowed by augmentation with suture tape, this procedure may protect the repaired ligament during healing by limiting excessiveROM after a ligament rupture.

Publication
The American Journal of Sports Medicine