Biomechanical Comparison of Reconstruction Techniques in Simulated Lateral Ankle Ligament Injury

Eighteen intact ankles were loaded with inversion- eversion and anterior-posterior forces, and motions of the talus and calcaneus were measured. Ankles were tested in neutral, 15° of dorsiflexion, and 15° of plantar flexion. The anterior talofibular ligament was then sec tioned and testing was repeated. In half the specimens the calcaneofibular ligament was also sectioned fol lowed by repeat testing. The Evans, Watson-Jones, and Chrisman-Snook procedures were performed on each ankle and testing was repeated. With inversion- eversion loading, only the Chrisman-Snook reconstruc tion resulted in a significantly more stable ankle joint complex than in the anterior talofibular ligament cut ankles. All three reconstructions increased ankle sta bility over the anterior talofibular and calcaneofibular ligament cut state. With anterior-posterior loading, all reconstructions resulted in a significantly more stable ankle joint complex than the anterior talofibular ligament cut ankles. The Evans and Chrisman-Snook proce dures resulted in more stability than the anterior talo fibular and calcaneofibular ligament cut ankles. There was no difference in subtalar joint motion with inversion- eversion loading among ankles with the anterior talo fibular ligament cut and those with any of the recon structions. For the anterior talofibular and calca neofibular ligament cut ankles, subtalar joint motion was similar to that in intact ankles after each reconstruction. All three reconstructions resulted in ankles with signifi cantly less subtalar joint motion with anterior-posterior loading than ankles with the anterior talofibular ligament cut or with the anterior talofibular and calcaneofibular ligaments cut. The Chrisman-Snook procedure resulted in ankles with significantly less motion than intact ankles.