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Operative Orthopädie und Traumatologie

, Volume 31, Issue 3, pp 169–179 | Cite as

Lateral collateral ligament repair

Anatomical ligament reinsertion with augmentation using inferior extensor retinaculum flaps
  • Yves TournéEmail author
  • Marco Peruzzi
Surgical Techniques
  • 131 Downloads

Abstract

Objective

For chronic lateral ankle instability an anatomical repair procedure of the lateral collateral ligaments (LCL) of the ankle with augmentation by an inferior extensor retinaculum (IER) flap is proposed.

Indications

To treat the mechanical parts of an instable ankle involving both LCL and subtalar joint ligament damage.

Contraindications

This technique is not suitable when the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are in a poor anatomical condition (exhaustive preoperative lesion mapping mandatory).

Surgical technique

This technique combines the reinsertion of the remnants of the lateral ligaments of the ankle, the ATFL and the CFL using anchors, with augmentation using an inferior extensor retinaculum flap fixed in a tunnel by an interference screw. This flap works as an actual neoligament, providing not only reinforcement and collagen input but also peripheral stabilization of the subtalar joint by its calcaneal insertion and reinforcing the CFL stabilizing effect.

Postoperative management

Following immediate immobilization in an ankle-foot orthosis, proprioceptive physiotherapy exercises are initiated with a return to sports depending on the type of sport.

Results

The postoperative outcomes and long-term follow-up results of this technique are discussed.

Keywords

Ankle instability Lateral collateral ligament laxity Ligament reconstruction Extensor retinaculum flap Subtalar joint 

Rekonstruktion des lateralen Kollateralbandapparats am oberen Sprunggelenk

Anatomische Reinsertion des Ligaments durch Augmentation mittels Retinaculum-extensorum-inferius-Flap

Zusammenfassung

Operationsziel

In diesem Beitrag wird ein Verfahren zur anatomischen Rekonstruktion des lateralen Kollateralbandapparats („lateral collateral ligaments“, LCL) des Sprunggelenks mittels Augmentation unter Verwendung eines Retinaculum-extensorum-inferius(IER)-Flaps zur Behandlung einer chronischen lateralen Sprunggelenkinstabilität vorgeschlagen.

Indikationen

Indikation ist die Behandlung eines mechanisch instabilen Sprunggelenks mit Beteiligung sowohl des LCL als auch einer Bandverletzung des Subtalargelenks.

Kontraindikationen

Diese Technik ist nicht geeignet, wenn sich das Lig. talofibulare anterius (ATFL) sowie das Lig. calcaneofibulare (CFL) massiv substanzgemindert sind (ein Mapping ist präoperativ unbedingt erforderlich).

Operationstechnik

Diese Technik kombiniert die Reinsertion der Residuen der Kollateralbänder des Sprunggelenks, des ATFL und des CFL mittels Ankern durch Augmentation unter Verwendung eines Retinaculum-extensorum-inferius-Flaps, der in einem Tunnel mittels einer Interferenzschraube fixiert wird. Dieser Retinakulumstreifen fungiert als eigentliches Neoligament, welches nicht nur eine substantielle Verstärkung bietet, sondern auch als periphere Stabilisierung des Subtalargelenks dient.

Weiterbehandlung

Nach unmittelbar postoperativer Immobilisation in einer Sprunggelenk-Fuß-Orthese wird mit propriozeptiven physiotherapeutischen Übungen begonnen. Die Rückkehr zum Sport hängt von der Sportart ab.

Ergebnisse

Die postoperativen und die Langzeit-Follow-up-Ergebnisse dieser Technik werden diskutiert.

Schlüsselwörter

Instabilität des Sprunggelenks Laxität des inneren und äußeren Seitenbands Bandrekonstruktion Retinaculum-extensorum-Flap Subtalargelenk 

Notes

Compliance with ethical guidelines

Conflict of interest

Y. Tourné is consultant for Arthrex, Stryker and In2Bones. M. Peruzzi declares that he has no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case. Additional written informed consent was obtained from the patient or the legal representative for whom identifying information is included in this article.

Supplementary material

Video: Anatomic lateral ligament ankle repair using ERF. Courtesy of Arthrex GmbH, München

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Foot and Ankle Institute of GrenobleCentre Ostéo Articulaire des CèdresEchirollesFrance
  2. 2.Largo Agostino Gemelli, Facoltà di Medicina e Chirurgia, Istituto di Ortopedia e TraumatologiaUniversità cattolica del Sacro CuoreRomaItaly

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