Long-Term Outcome of Anatomical Reconstruction Versus Tenodesis for the Treatment of Chronic Anterolateral Instability of the Ankle Joint: A Multicenter Study

• Published in: Foot & ankle international 2001-05, Vol.22 (5), p.415-421
• Main Authors: Krips, Rover, van Dijk, C. Niek, Halasi, Tamas, Lehtonen, Hannu, Corradini, Constantino, Moyen, Bernard, Karlsson, Jon
• Format: Article
• Language: English
• Subjects: Adult; Ankle; Ankle Joint - physiopathology; Ankle Joint - surgery; Chronic Disease; Female; Follow-Up Studies; Humans; Joint Instability - physiopathology; Joint Instability - surgery; Lateral Ligament, Ankle - surgery; Male; Postoperative Complications; Range of Motion, Articular; Retrospective Studies; Surgical Flaps; Tendons - surgery
• ISSN: 1071-1007; 1944-7876
• DOI: 10.1177/107110070102200510

The long-term clinical outcome after anatomical reconstruction and tenodesis in the treatment of chronic anterolateral ankle instability was assessed in a retrospective multicentre study. The first group (AR) consisted of 25 patients (mean age at operation 22 yrs ± 5.7) who underwent anatomical reconstruction and the second group (TE) of 29 patients (mean age 23 yrs ± 6.6) who underwent tenodesis. For both groups, the mean follow-up period was 12.3 yrs (AR ± 2.5 yrs, TE ± 2.7 yrs). At physical examination, there were significantly more patients in the TE group (n = 18) with a positive anterior drawer sign as compared with the AR group (n = 7) (p = 0.02). Medially located degenerative changes in the ankle joint as seen on standard radiographs were seen more often in the TE group (n = 7) than in the AR group (n = 1) (p = 0.03). The mean talar tilt, 4.7° in the AR group vs 6.9° in the TE group, (p = 0.02) and anterior talar translation, 2.9 mm in the AR group vs 4.3 mm in the TE group, (p = 0.04) were significantly higher in the TE group at radiographic stress examination. According to the rating system developed by Good et al. (1975), significantly fewer patients in the TE group (n = 8) had an excellent result as compared with the AR group (n = 15) (p = 0.03) and more patients in the TE group (n = 9) had a fair or poor result (p = 0.04) as compared with the AR group (n = 2). We conclude that a tenodesis procedure does not restore the normal anatomy of the lateral ankle ligaments. When compared with anatomical reconstruction, a tenodesis leads to inferior results in terms of functional and mechanical stability, as well as overall satisfaction at long-term follow-up.