A Closer Look At The Use Of Interference Screws For Lateral Ankle Stabilization

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Author(s): 
Erigena Baze, DPM, Danielle N. Butto and Lawrence DiDomenico, DPM

Given the common nature of ankle sprains and the fact that 85 percent involve lateral ankle ligament injury, these authors assess the research on techniques for lateral ankle stabilization and the use of interference screw fixation. They also offer pertinent step-by-step pearls on a technique that utilizes a split peroneus brevis tendon with interference screw fixation to help address chronic ankle instability.

An ankle sprain is one of the most common injuries that physicians evaluate in the emergency room. This injury commonly involves the lateral collateral ligaments. These acute ankle injuries can in turn become chronically unstable ankles due to recurring injuries. Residual symptoms after lateral ankle sprains can affect the injured patients for a significant period of time following the initial injury.

   Eighty-five percent of ankle sprains involve injury to the lateral ankle ligaments.1 The most common predisposition to suffering a lateral ankle sprain is the history of at least one previous ankle sprain, thus resulting in chronic ankle instability.1-5 Individuals with chronic ankle instability often suffer from joint instability, which may require surgical intervention.

   After attempts at non-operative care fail, providing stability and relief of symptoms is a challenging scenario for the foot and ankle surgeon. In scenarios in which surgical stabilization is necessary for a chronic unstable ankle, the surgeon must select the best procedure and optimal form of fixation to address the instability.

   Numerous stabilization techniques are in use to restore or repair the anterior talofibular and calcaneofibular ligaments. In the past, surgeons have implemented both anatomic and non-anatomic, as well as single repair techniques (anterior talofibular ligament) and double repair techniques (anterior talofibular and calcaneofibular ligaments).6 One can address this via primary or secondary repair of the anterior talofibular and/or calcaneofibular ligaments.

   When addressing the lateral ankle ligaments, one must consider the goals of the procedure, restoring anatomic configuration and encouraging a synergistic stabilization between the dynamic tendons and static ligaments.3 There are many procedures for reconstruction of the lateral ankle ligament complex. In addition to the variety of procedures, there is debate as to which means of fixation is the most appropriate.

What The Research Says About Reconstructive Ankle Procedures

The anterior talofibular ligament is the most frequent ligament damaged in ankle injuries followed by the calcaneofibular ligament. Injury to the posterior talofibular ligaments typically occurs only in severe ankle sprains.1-5

   The two potential causes of chronic ankle instability are mechanical instability and functional instability.2 Functional instability is defined as proprioceptive defects within injured ligaments leading to subjective giving away. Mechanical instability is motion beyond physiologic limits due to pathologic laxity of the injured ligaments. Pathologic instability can result in joint instability, most often in the talocrural and subtalar joints.2 One can assess joint stability clinically and radiographically by the talar tilt and anterior drawer test. With gross instability of talocrural and/or subtalar joints, it is necessary to re-approximate or recreate the lateral ankle ligamentous structures.

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