Quick Links
Customer Centres
Biomechanical comparison of ankle ligament reconstructive techniques
May 2005
| Principal Investigator: | Alastair Younger (University of British Columbia) | |
| Co-investigators: |
|
For more information about this study, please contact Dr. Alastair Younger.
Issue
Most cases of ankle sprain can be managed without surgery, but some cases become chronic and need surgery to repair ongoing ankle instability.
The most common surgical procedure for restoring ankle stability (called a Brostrom repair) repairs the damaged ligaments, and requires a protective cast after surgery. The researchers have developed a new surgical technique that uses a knee (hamstrings-gracilis) tendon, and aims to provide a stronger repair that would not require a cast and would allow for earlier rehabilitation.
Lab-based tests, using a cadaveric testing model, were conducted to compare the ankle biomechanics that resulted from the two types of surgeries.
Key findings
- Both the new technique (called a gracilis-graft reconstruction) and the standard Brostrom repair resulted in a close to normal range of motion for the reconstructed/repaired ankles.
- The results suggest gracilis-graft reconstruction is initially a stronger repair. However, this was a lab-based study, so the results do not take into account how the strength of the repair could be affected by biological healing processes.
Objectives
- To assess the biomechanics of the gracilis-graft reconstruction (new experimental method) compared with those of the Brostrom repair (standard method).
Method
Seven cadaveric ankle specimens were tested in the intact condition, after injury, and after surgery – using either the Brostrom repair (standard surgery) or the gracilis-graft reconstruction (new technique). Measurements of ankle stability and range of motion were taken in all three states.
Statistical analyses of the data were conducted to assess the differences between the outcomes of the two surgical techniques.
Results
Two of the Brostrom repairs failed to hold during testing. None of the gracilis reconstructions failed to hold.
There was no statistically significant difference in the range of motion resulting from the two types of surgeries. However, range of motion after the new technique more closely resembled the kinematics of a normal ankle and had greater ankle stability.
Conclusions
The results suggest the gracilis-graft reconstruction results in a normal range of motion but with a stronger repair and slightly higher degree of ankle stability compared with the standard surgical approach. Based on these results, the Principal Investigator has adopted earlier rehabilitation protocols for patients receiving the new reconstructive technique in his clinical practice.
Future directions
The earlier rehabilitation protocols and stronger reconstruction of the gracilis-graft reconstruction should enable earlier return to work, with less chronic pain and better long term ankle stability. However, clinical studies are needed to confirm this by evaluating the outcomes for patients undergoing the new technique and rehabilitation protocols.
Publications and presentations
A. Younger. Physical examination of the Foot and Ankle for Physicians: Nightime seminar March 9 th 2005, Executive Inn, Burnaby, B. C.
A. Younger. Family Practice Rounds: St. Paul’s Hospital: How to make the most of your foot and ankle referrals: November 28 2004.
A. Younger. Foot and Ankle: How a GP may help: General Practice Rounds, Mount St. Joseph’s Hospital. August 2004.
A. Younger. Referring tips for family physicians: Evening conference at Science World sponsored by Kintec. November 3 rd 2004.
A. Younger. “The diagnosis and treatment of the failed ligament reconstruction”. Invited Symposium presentation at the American Orthopaedic Foot and ankle society, Seattle, Washington July 2004.
A. Younger. Ankle Arthroscopy: Indications and techniques. Fall Course, Arthroscopy Association of North America. Palm Springs, December 2004.
A. Younger. Treatment options for osteochondral injuries of the talus: Arthroscopy association of North America specialty day at the American Academy of Orthopaedic Surgeons. Washington, D.C. February 2005.
A. Younger. Gracilis ligament reconstruction for ankle instability. Canadian Orthopaedic Foot and Ankle Society symposium, Vancouver, B,C, April 7 to 9, 2005.
A. Younger. Management of the Cavus foot in the Athlete; The American Orthopaedic Foot and Ankle Society Sports medicine of the foot and ankle course: Scotsdale, Arizona April 29 th, 2005.
A. Younger. The Role of Arthroscopy in Ankle Instability: The American Orthopaedic Foot and Ankle Society Sports Medicine of the Foot and Ankle Course: April 28 th to May 1 st, 2005.
A. Younger. Osteochondral lesions of the talus: Primary treatment: Arthroscopy association of North America Annual Meeting. May 2005. Vancouver, BC.
A. Younger. Canadian Orthopaedic Residents Association Meeting, Montreal, Quebec: Guest Lecture: Foot and ankle surgery: Past, present and future. June 3 r d2005.
A. Younger. COA annual meeting. Scientific presentation; Biomechancial comparison of ankle ligament reconstruction techniques. June 2005.
A. Younger. Arthroscopy Association of North America; Scientific presentation; Biomechanical comparison of ankle ligament reconstruction techniques, May 2005.
A. Younger: E poster: American Orthopaedic Foot and Ankle Society: biomechanical comparison of ankle ligament reconstruction techniques. July 2006.
A. Younger and D. Boyer: Anatomic reconstruction of the lateral ligament complex of the ankle using a gracilis autograft: In press – Foot and ankle clinics of North America.