Three-Dimensional computed tomography tunnel assessment of allograft anatomic reconstruction in chronic ankle instability: 33 cases
- Authors
- Dhong Won Lee; In Keun Park; Min Jeong Kim; Woo Jong Kim; Min Soo Kwon; Sung Jin Kang; Jin Goo Kim; Young Yi
- Issue Date
- Feb-2019
- Publisher
- Elsevier Masson
- Keywords
- Ankle lateral ligament; Lateral ankle instability; Anatomic reconstruction; Bone tunnel; 3 Dimensional computed tomography
- Citation
- Orthopaedics and Traumatology: Surgery and Research, v.105, no.1, pp.145 - 152
- Indexed
- SCIE
SCOPUS
- Journal Title
- Orthopaedics and Traumatology: Surgery and Research
- Volume
- 105
- Number
- 1
- Start Page
- 145
- End Page
- 152
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/148303
- DOI
- 10.1016/j.otsr.2018.10.008
- ISSN
- 1877-0568
- Abstract
- Introduction
Although clinical results of anatomic reconstruction using allograft are reportedly good, studies on how accurately the tunnel has been made after surgery are very rare. The purpose of this study was to analyze the postoperative locations of the tunnels through 3-dimensional computed tomography (3D-CT) after anatomic ligament reconstruction and to evaluate its clinical results.
Hypothesis
We hypothesized that anatomic lateral ligament reconstruction could lead to excellent results in clinical outcomes by repositioning anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) accurately.
Materials and methods
Thirty-three special forces of soldiers who were diagnosed as chronic ankle instability (CAI) were included. Visual analogue scale (VAS), American orthopaedic foot and ankle society (AOFAS) ankle-hind foot functional scores, and Tegner activity scale were comparatively analyzed before the surgery and at final follow-up. The locations of the talar, fibular and calcaneal tunnels were evaluated with 3D-CT taken after the surgery. Talar tilt and anterior drawer displacement were measured on stress radiographs.
Results
The mean follow-up period was 26.8 ± 3.6 months. The VAS decreased from 6.9 ± 1.6 to 1.7 ± 1.3, AOFAS ankle-hindfoot functional score increased from 61.3 ± 14.8 to 88.7 ± 9.2, and Tegner activity scale improved from 5.3 ± 1.2 to 6.4 ± 1.3 (p < 0.001). Talar tunnel for ATFL was located about68% of the way from the lateral talar process, and fibular tunnels for ATFL and CFL were approximately 52% and 20% of the way from the fibular tip. The calcaneus tunnel was approximately 17 mm posterosuperior from the peroneal tubercle on 3D-CT. Talar tilt decreased from 15.8 ± 4.8 to 3.9 ± 2.1 degrees (p < 0.001). There were excellent inter-observer agreements for CT evaluation (Kappa values were from 0.83 to 0.92). There was no relapse of lateral instability.
Discussion
Anatomic reconstruction of the lateral ligaments using allograft and the interference screw for CAI showed good results in postoperative stability and subjective clinical evaluation by repositioning the location of ATFL and CFL accurately on radiological determination.
Level of evidence
IV, Case-series.
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