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Lateral Ligament Reconstruction, Ankle
Julia R. Crim, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Definitions

          • Broström procedure
            • Direct repair and plication of lateral collateral ligament (LCL) complex
            • Always includes anterior talofibular ligament (ATFL)
            • May also include calcaneofibular ligament (CFL)
          • Gould modification of Broström procedure
            • Repair of ATFL ± CFL, augmented by inferior extensor retinaculum
            • Surgery currently most recommended
          • Anatomic reconstruction
            • Utilizes tendon allografts
          • Peroneus brevis (PB) tendon used for variety of nonanatomic repairs
            • PB tendon loop
              • PB is cut, distal portion looped through horizontal fibular tunnel, reattached to distal PB
            • Watson-Jones procedure
              • PB is cut, distal portion looped through fibula, talar neck, back through fibula, reattached to distal PB
            • Chrisman-Snook procedure
              • PB is split, anterior portion looped through fibula, attached to periosteum of talus and calcaneus and reattached to distal PB
            • Evans procedure
              • PB is cut, routed through vertical fibular tunnel, reattached to peroneus longus distally

        IMAGING

        • Radiographic Findings

          • MR Findings

            • Ultrasonographic Findings

              • Imaging Recommendations

                CLINICAL ISSUES

                • Presentation

                  • Natural History & Prognosis

                    DIAGNOSTIC CHECKLIST

                    • Reporting Tips

                      Selected References

                      1. Jung HG et al: Anatomical reconstruction of lateral ankle ligaments using free tendon allografts and biotenodesis screws. Foot Ankle Int. 36(9):1064-71, 2015
                      2. Wainright WB et al: The effect of modified Broström-Gould repair for lateral ankle instability on in vivo tibiotalar kinematics. Am J Sports Med. 40(9):2099-104, 2012
                      3. Ferran NA et al: Ankle instability. Sports Med Arthrosc. 17(2):139-45, 2009
                      4. Li X et al: Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Broström repair using suture anchors. Am J Sports Med. 37(3):488-94, 2009
                      5. Chien AJ et al: Imaging appearances of lateral ankle ligament reconstruction. Radiographics. 24(4):999-1008, 2004
                      6. Colville MR: Surgical treatment of the unstable ankle. J Am Acad Orthop Surg. 6(6):368-77, 1998
                      7. Liu SH et al: Comparison of lateral ankle ligamentous reconstruction procedures. Am J Sports Med. 22(3):313-7, 1994
                      Related Anatomy
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                      Related Differential Diagnoses
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Terminology

                        • Imaging

                          • Diagnostic Checklist

                            TERMINOLOGY

                            • Definitions

                              • Broström procedure
                                • Direct repair and plication of lateral collateral ligament (LCL) complex
                                • Always includes anterior talofibular ligament (ATFL)
                                • May also include calcaneofibular ligament (CFL)
                              • Gould modification of Broström procedure
                                • Repair of ATFL ± CFL, augmented by inferior extensor retinaculum
                                • Surgery currently most recommended
                              • Anatomic reconstruction
                                • Utilizes tendon allografts
                              • Peroneus brevis (PB) tendon used for variety of nonanatomic repairs
                                • PB tendon loop
                                  • PB is cut, distal portion looped through horizontal fibular tunnel, reattached to distal PB
                                • Watson-Jones procedure
                                  • PB is cut, distal portion looped through fibula, talar neck, back through fibula, reattached to distal PB
                                • Chrisman-Snook procedure
                                  • PB is split, anterior portion looped through fibula, attached to periosteum of talus and calcaneus and reattached to distal PB
                                • Evans procedure
                                  • PB is cut, routed through vertical fibular tunnel, reattached to peroneus longus distally

                            IMAGING

                            • Radiographic Findings

                              • MR Findings

                                • Ultrasonographic Findings

                                  • Imaging Recommendations

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Natural History & Prognosis

                                        DIAGNOSTIC CHECKLIST

                                        • Reporting Tips

                                          Selected References

                                          1. Jung HG et al: Anatomical reconstruction of lateral ankle ligaments using free tendon allografts and biotenodesis screws. Foot Ankle Int. 36(9):1064-71, 2015
                                          2. Wainright WB et al: The effect of modified Broström-Gould repair for lateral ankle instability on in vivo tibiotalar kinematics. Am J Sports Med. 40(9):2099-104, 2012
                                          3. Ferran NA et al: Ankle instability. Sports Med Arthrosc. 17(2):139-45, 2009
                                          4. Li X et al: Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Broström repair using suture anchors. Am J Sports Med. 37(3):488-94, 2009
                                          5. Chien AJ et al: Imaging appearances of lateral ankle ligament reconstruction. Radiographics. 24(4):999-1008, 2004
                                          6. Colville MR: Surgical treatment of the unstable ankle. J Am Acad Orthop Surg. 6(6):368-77, 1998
                                          7. Liu SH et al: Comparison of lateral ankle ligamentous reconstruction procedures. Am J Sports Med. 22(3):313-7, 1994