The Clinical Research Of Anterior Talofibular And Calcaneofibular Ligament Reconstruction With Anterior Half Of The Peroneus Longus Tendon Under Arthroscopy

Objective: To research the clinical results of a novel surgical technique for the anterior talofibular and calcaneofibular ligament reconstruction with anterior half of the peroneus longus tendon autografts under arthroscopy and comparison of the modified Brostr?m procedure and the effects of anterior half of the peroneus longus tendon removing on ankle joint stability and function.Methods : From July 2013 to May 2015,40 patients with chronic lateral ankle instability were recruited in this study.All patients were injured more than 6 months and after the non-surgery treatment and rehabilitation exercise,the symptoms improved non-significantly and with recurrent ankle sprain.There were 23 males and 17 females,with a mean age of 31 years(range,18 to 55 years).24 consecutive patients underwent anterior talofibular and calcaneofibular ligament reconstruction with anterior half of the peroneus longus tendon autografts under arthroscopy.Ligaments were fixed with Tunnel combined screws under arthroscopy and 16 consecutive patients were treated with modified Brostr?m procedure.The American Orthopaedic Foot and Ankle Society(AOFAS)scores and standard stress radiographs were used to analysis the patients preoperation and at the last follow-up.Contrast the variation of the anterior translation of talus(ATT)and talar tilt(TT)before and after the operation.And the operation time and complications were compared between the two groupsResults: followed-up for average 20±5.8 months and 24.3±5.1 months after operation.The average preoperative AOFAS score was 54.3±3.8 and 57.7±4.6,The final average AOFAS score increased to 95.1±2.3 and 89.1±3.5 in two groups(P=0.000,P<0.01).The improved American Orthopaedic Foot and Ankle Society score in the peroneus longus tendon group was significantly higher than that in the modified Brostr?m group(P=0.000,P<0.01).In peroneus longus tendon group,the mean talar tilt angle significantly improved from16.5°±1.3° preoperatively to 5.1°±1.1° at the last follow-up,and the mean anterior talar translation significantly improved from 7.6±1.2 mm preoperatively to 3.9±0.8mm at the last follow-up(P=0.026 and 0.035).In modified Brostr?m group,the mean talar tilt angle significantly improved from17.0°±1.8° preoperatively to 5.9°±0.7° at the last follow-up,and the mean anterior talar translation significantly improved from 7.8±0.9mm preoperatively to 4.6±0.7mm at the last follow-up.The average operation time was 70.2 ± 12.7min and 68.5±14.8 min(P=0.421).There were no cases of postoperative infection and incision healing,secondary fracture,anchor screw loosening and other complications.There were no serious complications and no signs of peroneal nerve injury or peroneus longus tendon rupture in peroneus longus tendon group?Conclusion:1?Using anterior half of the peroneus longus tendon autografts reconstrut anterior talofibular and calcaneofibular ligament procedure under arthroscopy or the modified Brostr?m procedure can improve the patients' ankle function and stablity.2?There was no significant difference between using anterior half of the peroneus longus tendon autografts reconstrut anterior talofibular and calcaneofibular ligament procedure under arthroscopy and the modified Brostr?m procedure in terms of stablity after operation.3?The curative effect in the anterior half of the peroneus longus tendon under arthroscopy group was higher than that in the modified Brostr?m group.4?Arthroscopic technique allows simultaneous treatment of concomitant intra-articular pathologies and and provides smaller incision under arthroscopy and potential earlier postoperative rehabilitation.