Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft

PURPOSE: The purpose of this retrospective study was to assess the results of a novel surgical technique for the treatment of chronic lateral ankle instability using both a direct repair of the anterior talofibular ligament and a free gracilis tendon transfer to reconstruct anatomically the anterior talofibular and calcaneofibular ligaments. METHODS: Between December 1998 and February 2002, 28 patients (29 ankles) underwent an anatomic reconstruction of the lateral ankle ligaments for chronic ankle instability. Patients returned for a clinical and radiologic follow-up evaluation at an average of 23 months following surgery (range, 12-52 months). Outcomes were assessed by comparison of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analog pain scores as well as a postoperative Karlsson score. A subjective self-assessment rating was also obtained. All patients underwent preoperative and postoperative radiographic assessment including talar tilt and anterior drawer stress radiographs. RESULTS: Twenty-eight patients (29 ankles) (100%) returned for final evaluation. Good or excellent outcome was noted on patient subjective self-assessment, pain scores, AOFAS, and Karlsson scores at final follow-up in all patients. Ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was reduced from a mean of 13 degrees to 3 degrees (p <.0001) and the anterior drawer was reduced from a mean of 10 mm to 5 mm (p <.0001) by the lateral ankle ligamentous reconstruction. CONCLUSION: In the present study, lateral ankle reconstruction with a direct anterior talofibular ligament repair and free gracilis tendon graft augmentation resulted in a high percentage of successful results, excellent ankle stability with a minimal loss of ankle or hindfoot motion, and marked reduction of pain at an average follow-up of almost 2 years.     

Reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft

Thirty-one consecutive ankles in 30 patients with chronic lateral ankle instability were reconstructed using a split peroneus brevis tendon graft. All patients had pain and instability despite adequate treatment and a rehabilitation program. Six patients had clinical and radiographic evidence of associated subtalar laxity. Four patients (four ankles) had prior Brostrom ligament reconstructions. The average time from the initial injury or treatment to surgery was 23 months. At a mean follow-up of 44 months (range, 24-64 months), the functional results included excellent in 20 ankles, good in 9, fair in 1, and poor in 1. Ankle stability, which did not deteriorate with time, was achieved in 30 of 31 ankles. This procedure is simple, safe, and reliable with a 94% good to excellent clinical result and 97% mechanical stability. It is an excellent reconstruction choice for those individuals with high demand ankles, with a longstanding ankle instability with or without subtalar instability, and for failed primary reconstruction.     

踝关节外侧结构重建治疗踝关节外侧不稳

目的：探讨踝关节外侧结构重建在治疗慢性踝关节外侧不稳中的作用。方法：回顾分析2005年7月至2008年1月收治的13例慢性踝关节不稳患者,男10例,女3例;年龄24～45岁,平均33岁。13例均采用自体半束腓骨短肌腱解剖重建距腓前韧带和跟腓韧带（Sammarco法）,手术前后按踝关节评分系统进行评分,评分项目包括稳定性、疼痛、活动能力、X线表现。结果：13例均获随访,时间6～32个月,平均16.4个月,患者踝关节评分在稳定性、疼痛、活动能力等方面均有所改善,踝关节评分由术前的平均（43.54±7.04）分提高至术后的（73.38±4.17）分,手术前后差异有统计学意义（P〈0.01）。全部患者对手术表示满意。结论：采用半束自体腓骨短肌腱解剖重建距腓前韧带及跟腓韧带的方法治疗踝关节外侧不稳,操作便利,对于以关节不稳为主要表现的患者,疗效确切。     

Modified Broström-Gould With Gracilis Autograft Augmentation Surgery and Accelerated Noncasted Rehabilitation in High Demand Patients With Lateral Ankle Instability

Lateral ankle instability that has failed conservative management can be physically debilitating. Good outcomes are obtained from Broström-Gould augmented repair techniques, however there are few studies evaluating the use of a gracilis autograft augmentation coupled with an accelerated rehabilitation program in high functional demand patients. We believe that the modified Broström-Gould technique utilizing a Gracilis autograft will provide significant improvements in stability while maintaining normal ankle biomechanics in young, high demand patients. The prospective cohort study involved 19 patients (20 ankles) who underwent surgery for chronic lateral ankle instability by a single surgeon, at a single institution between October 2014 and April 2016. Patients were followed for 33.8 ± 11.7 (range 12-48) months. Patients were assessed both pre- and postoperatively for talar tilt angle radiographically and with both American Orthopaedic Foot and Ankle Society Ankle and Hindfoot scores and Karlsson-Peterson scores. A Tegner activity score was taken at the last follow-up. The mean American Orthopaedic Foot and Ankle Society score increased from 68.85 ± 10.57 to 91.56 ± 5.31 points (p < .01) and mean Karlsson-Peterson score increased from 50.9 ± 15.53 to 88.11 ± 8.64 points (p value <.01) when compared preoperatively to mean postoperative follow-up of 33.8 months. Tegner activity score was 7.05 ± 0.89 at last follow-up. The technique was found to be effective in treating chronic lateral ankle instability and in combination with an accelerated rehabilitation protocol, patients returned to their premorbid level of activity with improved stability and no significant effect on donor graft site morbidity.     

Comparison of symptomatic unstable ankle with and without os subfibulare

BackgroundThis study aimed to compare the patients background, clinical scores, condition of the lateral ligament, mechanical instabilities, and chondral lesions in ankles with symptomatic os subfibulare compared to those in ankles with chronic lateral instability without os subfibulare.MethodsOf the 212 ankles with a chronic lateral instability that were surgically treated, 72 ankles had an os subfibulare. All ankles were examined by arthroscopy during surgery. Age, sex, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot Scale scores, remnant condition of the lateral ligaments, and chondral lesions were compared between ankles with symptomatic os subfibulare and ankles with chronic lateral instability without os subfibulare.ResultsThere were no statistically significant differences between the groups in terms of the sex ratio (males: females, 35:37 vs. 53:87, n.s.) and the AOFAS Ankle–Hindfoot Scale scores (median; 75 vs. 77, n.s.). There were statistically significant differences in patient age (median: 20 vs. 24.5 years, p < 0.01), talar tilt angle (median: 9.0° vs 12.0°, p < 0.01), anterior drawer distance (6.2 vs. 7.0 mm, p < 0.01), chondral lesions (G0:G1:G2:G3, 35:21:66:5 vs. 40:44:27:29, p < 0.01), condition of the anterior talofibular ligament (intact: repairable remnant: poor remnant, 0:70:2 vs. 1:112:27, p < 0.01), and condition of the calcaneofibular ligament (intact: repairable remnant: poor remnant, 44:26:2 vs. 77:35:28, p < 0.01) between the groups.ConclusionThis study suggests that the condition of the lateral ligaments including mechanical instability and cartilage of the ankle were less severe in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The patients’ age was lower in the ankles with symptomatic os subfibulare than in those with chronic lateral instability without os subfibulare. The clinical scores and gender ratio were not statistically different between the group.     

Chronic lateral ankle instability and associated conditions: a rationale for treatment

BACKGROUND: Ankle sprains have a high incidence of associated injuries and conditions that may be unrecognized at the initial time of injury. Failure to treat these conditions at the index surgery may compromise outcomes and delay recovery. The purpose of this study was to determine the type and frequency of associated injuries and conditions in military patients with chronic lateral ankle instability. METHODS: Between 1996 and 2002, 160 patients had 180 modified Brostr?m-Gould lateral ankle ligament reconstructions for chronic ankle instability. A retrospective review of the clinical history, physical examination, radiographs, and intraoperative findings was conducted. RESULTS: The overall incidence of associated extra-articular conditions and injuries found in this study was 64%; 115 conditions were identified in 180 ankles. Peroneal tendon injuries occurred with the highest frequency (28%), followed by os trigonum lesions (13%), lateral gutter ossicles (10%), hindfoot varus alignment (8%), anterior tibial spurs (3%), and tarsal coalitions (2%). Twenty revision lateral ankle ligament reconstructions were required for either persistent pain or recurrent instability. The most common associated conditions were undiagnosed hindfoot varus alignment abnormalities (28%) followed by untreated peroneal injuries (25%). CONCLUSIONS: This study confirms the frequency of conditions associated with lateral ankle instability and emphasizes several conditions that have received little attention in the literature. Identifying these associated conditions before surgery enables the surgeon to treat all conditions at one operation, returning the patient to full activity sooner. Guidelines are presented to assist clinicians in screening patients for these associated conditions.     

The “All Inside” Arthroscopic Broström Procedure: A Prospective Study of 40 Consecutive Patients

Lateral ankle sprains are the most common injury in sports. Nonoperative therapy is recommended initially, including functional rehabilitation. Surgery might be an option for those patients in whom nonoperative attempts fail. Various surgical approaches have been described in published studies for treating chronic lateral ankle instability. The procedures are typically grouped into 2 main categories: anatomic and nonanatomic repair of the lateral ligament complex. The open modified Broström-Gould anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. In the present study, we used an arthroscopic approach to treat chronic anterior talofibular ligament tears without the extensive open incisions common in the traditional modified Broström-Gould procedure. Our hypothesis was that the use of an all-inside arthroscopic Broström procedure would provide a minimally invasive technique with acceptable patient outcomes. We also wished to explore the complication rates and interval to return to weightbearing activity. A total of 40 ankles in 40 consecutive patients were included in the cohort.     

A novel reconstruction technique for chronic lateral ankle instability: comparison to primary repair

Twenty patients with lateral ankle instability were treated by a novel anatomical reconstruction technique (group A) and the results compared with 20 patients (group B) who, during the same period of time, underwent primary repair of ruptured lateral ligaments of the ankle. We reviewed 15 patients from group A and 17 patients from group B at a mean follow-up of between 2 and 4 years. The mean functional scores were good in both groups without significant difference, and there was no difference in the mean anterior talar translation between the two groups. We therefore conclude that chronic lateral instability of the ankle may be successfully treated, even in the presence of severely damaged, attenuated or absent ligament tissue.     

Long-term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle

The Chrisman-Snook procedure for instability of the lateral ankle ligaments, first described in 1969, reconstructs the anterior talofibular ligament and the calcaneofibular ligament using one-half of the peroneus brevis tendon, routed through tunnels in the fibula and calcaneus. In the present long-term evaluation of the results of this procedure, forty-eight of sixty ankles, in fifty-seven patients, were assessed after a mean follow-up of ten years (range, four to twenty-four years). The results were excellent in thirty-eight ankles, good in seven, fair in two, and poor in one. The two ankles with a fair result were improved but still had some persistent instability, while the ankle with a poor result (no improvement) was in a patient with generalized ligament laxity. All three patients with a fair or poor result had had a severe reinjury to the ankle. Based on the findings in this study, we concluded that this procedure will restore good long-term function in a high percentage of patients who are disabled by ankle instability due to unhealed or neglected tears of the lateral ligaments.     

Anatomic reconstruction of the lateral ligaments of the ankle using a plantaris tendon graft

The purpose of this work was to present our technique of anatomic reconstruction of the lateral ankle ligaments using a free plantaris tendon graft. Between 1988 and 1997, 52 ankles (48 patients) were treated for chronic ankle instability resisting to a training program of minimally 3 months. The average age was 28.6 years (16 to 46 years) at the time of surgery. There were 30 ankles in men and 22 ankles in females. 4 patients were treated on both ankles. 50 ankles were available for a follow-up investigation after a mean of 3.5 years (1 to 10 years). Based on the AOFAS-Hindfoot-Scale an average score of 97.9 points (90 to 100 points) was found. The functional result was found to be excellent in 39 ankles (78 %), good in 9 ankles (18 %), fair in 2 ankles (4 %), and poor in 0 ankle (0 %). Dorsi-/plantarflexion was not restricted in any ankle. Supination was slightly restricted in 2 ankles, but not increased in any ankle. High patient's satisfaction with respect to the achieved stability was found in all but one ankle. No deterioration with time was observed in any case. The overall good and excellent results with this method may be explained by the strictly anatomic reconstruction that did not alter the kinematics nor the mechanics of the ankle joint complex. In addition the peroneal tendons were not weakened. We feel that this procedure is a better alternative to other more complex ligament reconstructions, especially tenodesis operations by using the peroneal tendon.     

A surgical approach to the problem of severe lateral instability at the ankle

A unified approach to ligamentous instability of the lateral side of the ankle was investigated in 100 ankles of 81 patients (age range, ten to 59 years). The approach consisted of augmentation of the collateral ligament system by means of the anterior portion of the peroneus brevis passed forward through the fibula and secured to the talocalcaneal interosseous ligament. In addition, torn ligaments were repaired or tightened in some cases. One hundred seven operations were performed between 1977 and 1983. Ninety-seven ankles were restored to clinical stability; 83 ankles were essentially asymptomatic. All three ankles that did not ultimately stabilize were in adolescent girls with chronic instability, one of whom was treated by three procedures. Of the remaining five repeat procedures, four had been adolescent girls initially treated for chronic ankle instability.     

Medial malleolar osteotomy for the correction of varus deformity during total ankle arthroplasty: results in 15 ankles

BACKGROUND: Preoperative deformity in the frontal plane in the arthritic ankle is a risk factor for failure after total ankle arthroplasty. Medial malleolar lengthening osteotomy was developed to correct varus malalignment. MATERIALS AND METHODS: From 1998 to 2005 total ankle arthroplasty combined with medial malleolar lengthening osteotomy was done in 15 ankles (13 patients) with a mean preoperative varus deformity of 14.9 (SD, 7.8) degrees. Diagnosis was arthritis with instability in 11 ankles (9 patients) and inflammatory joint disease in 4 ankles. Two mobile-bearing designs were used. Osteosynthesis of the osteotomy was done in 2 ankles; for the remaining 13 osteotomies, no fixation was used. RESULTS: Followup was 5 (range 2 to 8) years. Neutral alignment was obtained in all ankles. In 3 patients residual hindfoot varus remained, for which a second-stage hindfoot correction was done. Two rheumatoid ankles developed a symptom-free nonunion of the medial malleolus, all other malleolar osteotomies united. One tibial component, implanted with too much anterior slope, developed early aseptic loosening and was revised. Debridement for talar-malleolar arthritis was done in two ankles. Of the 14 ankles in followup, 12 were rated as excellent or good, one as fair. One ankle with subsidence of the talar component was rated as unsatisfactory. AOFAS score increased from 30.8 preoperative to 81.0 at followup (p < 0.01). CONCLUSION: Medial malleolar lengthening osteotomy is an easy technique for the realignment of the varus ankle at the time of total ankle arthroplasty, and served as an alternative to medial ligament release or lateral ligament reconstruction.     

An autogenous free graft technique for lateral ankle stabilization

A recent advancement in the surgical treatment of chronic lateral ankle instability is presented. The authors have collected data from 401 surgical stabilizations of the lateral ankle performed at the Waldo Podiatric Residency Program. A data summary is presented to provide the reader an appreciation of the evolution in treatment of ankle instability at this institution. The free tendon graft method of lateral ankle ligament reconstruction is also presented as performed on 37 patients with chronic unstable ankles.     

Reconstruction for chronic lateral ankle instability using the palmaris longus tendon: is reconstruction of the calcaneofibular ligament necessary?

The palmaris longus tendon was used to reconstruct the anterior talofibular ligament (ATFL) in 27 ankles with chronic lateral instability. The mean age of the patients at surgery was 23 years, and the follow-up was more than 2 years. The functional evaluation showed excellent or good results in all ankles. Twenty-seven ankles were divided into two groups according to operative findings: group A consisted of 11 ankles with old isolated injury of the ATFL, and group B consisted of 16 ankles with old combined injuries of the ATFL and the calcaneofibular ligament. There were no significant differences in clinical results between group A and group B. The preoperative mean talar tilt angles on stress radiograph in group B were significantly larger than those in group A. At follow-up, there were no significant differences in the mean talar tilt angles between group A and group B. We demonstrate that reconstruction of the calcaneofibular ligament along with the ATFL is not necessary for patients with chronic combined lateral ligament instability.     

3D MRI evaluation of morphological characteristics of lateral ankle ligaments in injured patients and uninjured controls

BackgroundWith ultrasonography or 2D magnetic resonance imaging (MRI) of the lateral ankle ligament, it is particularly difficult to show the entire calcaneofibular ligament (CFL). The purpose of this study was to evaluate the morphological characteristics of the lateral ankle ligaments in injured patients and uninjured controls using 3D MRI.MethodsA total of 64 ankles of 59 healthy volunteers and lateral ligament injury patients (mean age of 32.4 years) were examined. The 64 ankles included a healthy group of 11 ankles, an acute injury group of 12 ankles that underwent MRI a month after injury, and a chronic injury group of 41 ankles that underwent MRI more than 3 months after injury. Using a 3.0-T MRI system, imaging was done with fast imaging employing steady-state acquisition cycled phases. Oblique sagittal images that most clearly depicted the entire anterior talofibular ligament (ATFL) and CFL were prepared manually and evaluated using a workstation.ResultsIn the healthy group, both the ATFL and CFL were clearly and entirely visualized. The mean width in the central portion was 4.0 ± 1.0 mm in the ATFL and 4.8 ± 0.6 mm in the CFL. 3D MRI in the acute injury group showed findings of diffuse swelling with hyperintensity in the ATFL of all patients. The CFL in 7 of 12 ankles showed findings of diffuse swelling with hyperintensity. In the chronic injury group, morphological abnormalities of the ATFL were seen in 19 of 41 ankles. The ligament signal disappeared in 2 ankles, thinned in 4 ankles, and showed swelling in 13 ankles. Morphological abnormalities of the CFL were seen in 17 of 41 ankles. The ligament signal disappeared in 1 ankle, thinned in 2 ankles, and showed swelling in 14 ankles.Conclusion3D MRI may be a useful modality to visualize both the ATFL and the CFL.     

自体肌腱移植解剖重建慢性踝关节外侧不稳定

目的 探讨采用自体半腱肌肌腱移植对不同类型慢性踝关节外侧不稳定患者进行韧带解剖重建的临床疗效.方法 2008年10月至2009年10月收治16例慢性踝关节外侧不稳定患者,男8例,女8例;年龄19～47岁(平均28.2岁).首先在麻醉下对慢性踝关节外侧不稳定患者进行应力X线片评估:对于前抽屉应力片距骨前移大于4 mm的患者,采用距腓前韧带重建,共9例;对于距骨倾斜应力片距骨倾斜角度大于10°的患者,采用距腓前韧带和跟腓韧带重建,共7例.韧带移植物采用自体半腱肌肌腱,用带线锚钉固定移植物于腓骨端,用可吸收界面螺钉固定韧带于距骨端或跟骨端.采用美国足踝外科协会(AOFAS)踝与后足评分系统对患者手术前、后的结果进行评估.采用标准应力X线片对患者手术前、后客观结果进行评估.结果 16例患者术后获6～18个月(平均12.1个月)随访.16例患者AOFAS踝与后足评分由术前的(70.50±3.98)分改善为末次随访时的(93.06 ±4.78)分,差异有统计学意义(t=-24.010,P=0.000);距骨前移距离由术前的(8.75±3.38)mm改善为末次随访时的(3.51±1.63)mm,差异有统计学意义(t=7.028,P=0.000).7例患者距骨倾斜角度由术前的16.18°±7.30°改善为术后的5.57°±2.99°,差异有统计学意义(t=5.661,P=0.001).16例患者中仅1例背屈受限10°,无严重并发症发生.结论 解剖重建外踝韧带治疗慢性踝关节外侧不稳定是一种有效的治疗方法,其具有解剖重建、固定牢固、对腓骨和腓骨肌腱影响小、能够有效节省游离肌腱的长度等优点.     

Long-term results of the Weber operation for chronic ankle instability: 37 patients followed for 20-30 years

BACKGROUND: The Weber operation is an anatomical reconstruction of the anterior talofibular ligament with the plantaris tendon. Few long-term studies have been published. METHODS: We evaluated 40 ankles in 37 patients (19 women) at an average of 24 years after the procedure. RESULTS: At follow-up, symptoms were present to vary-ing degrees in half of the ankles, but 32 patients were satisfied with the result and approximately two-thirds of the patients had a good or excellent result with the Karlsson and Good scores. Only 3 ankles had secondary arthrotic changes with narrowing (2 patients) or disappearance (1 patient) of the joint space. INTERPRETATION: We conclude that the Weber procedure is a good alternative for treatment of chronic anterolateral ankle instability when a direct anatomical reconstruction is not feasible, or has failed.     

关节镜下自体半腱肌肌腱解剖重建踝关节外侧副韧带

目的 探讨关节镜下自体半腱肌肌腱重建踝关节外侧副韧带治疗慢性踝关节不稳定的方法及初期临床疗效。方法 将2015年12月至2017年2月我院收治的16例慢性踝关节不稳定病人纳入研究,其中男14例,女2例,年龄为（28.1±6.4）岁;术前应力位X线片提示距骨倾斜25.5°±5.5°（18°~35°）,距骨前移（10.1±1.8） mm（7~14 mm）。采用2.7 mm 30°短踝关节镜经前外侧入路观察,经前外侧辅助入路于腓骨远端和距骨外侧面距腓前韧带足印区制作骨隧道,跟骨外侧壁跟腓韧带止点处经皮透视制作骨隧道,取自体半腱肌肌腱对折编织成“Y”型,将移植物引入骨隧道,腓骨端使用袢钢板悬吊固定,距骨及跟骨端使用5.0 mm界面螺钉固定。术后早期功能锻炼,末次随访应用美国足踝外科医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝与后足功能评分系统评价踝关节功能;采用疼痛视觉模拟量表（visual analogue scale, VAS）评估疼痛情况;采用Sefton外侧副韧带重建疗效评价系统评估踝关节稳定性。结果 本组16例病人术后随访（16.8±4.3）个月（12~24个月）,均于术后3个月恢复正常体育活动,末次随访未观察到踝关节不稳定复发。AOFAS评分为（89.2±4.8）分,VAS评分为（0.7±0.6）分。依据Sefton评价标准：优9例,良5例,可2例,优良率为87.5%。结论 关节镜下自体半腱肌肌腱解剖重建踝关节外侧副韧带治疗慢性踝关节不稳定的近期疗效理想,并发症较少。     

3D打印个体化导板在踝关节外侧韧带解剖重建中的应用

目的探讨3D打印个体化钻孔导板建立的腓骨通道用于韧带解剖重建治疗慢性踝关节外侧不稳定的疗效。方法回顾性分析2012年l0月至2015年6月华中科技大学附属普爱医院足踝外科收治的15例慢性踝关节外侧不稳定患者资料,男4例,女11例;年龄18~42岁,平均26.3岁。均采用3D打印个体化钻孔导板建立腓骨通道,通过腓骨通道进行韧带解剖重建。比较术前和末次随访时患者的美国足踝外科协会(AOFAS)的踝-后足评分、疼痛视觉模拟评分(VAS)。结果15例患者术后获12~18个月(平均15.2个月)随访。AOFAS的踝-后足评分由术前的(47.1±3.8)分提高至末次随访时的(88.3±4.7)分,VAS评分由术前平均(5.8±1.8)分降至末次随访时的(1.6±1.3)分,差异均有统计学意义(P<0.05)。AOFAS的踝-后足评分评价:优良11例,可4例。无严重并发症发生。结论3D打印个体化钻孔导板建立腓骨通道用于重建慢性踝关节外侧不稳定的韧带时可以精准化、个性化,且疗效肯定。     

Clinical outcome after anatomical reconstruction of the lateral ankle ligaments using the Duquennoy technique in chronic lateral instability of the ankle: a long-term follow-up study

We performed a retrospective study to assess the long-term outcome of non-augmented anatomical direct repair of the lateral ankle ligaments, as originally described by Duquennoy et al, for the treatment of chronic lateral instability of the ankle. This procedure aims to restore stability by the re-insertion and tightening of the original talofibular and calcaneofibular ligaments without division of the ligament. We examined the outcome in terms of the post-operative quality of life, the function of the joint and the development of osteoarthritis. Between 1985 and 2002, 23 patients (11 males, 12 females) with a mean age of 32 years (15 to 58) who had undergone this procedure completed the Short-Form 36 assessment of quality of life and the Olerud and Molander Ankle score for the subjective evaluation of symptoms. Clinical re-evaluation, including examination of the ankle and the completion of the American Orthopaedic Foot and Ankle Society questionnaire was performed on 21 patients after a mean follow-up of 13 years (3 to 22.2). At the final follow-up radiographs of both ankles were taken to assess the development of osteoarthritis. The mean total Short-Form 36 and Olerud and Molander Ankle scores in 23 patients at final follow-up were 79.6 points (37 to 100) and 81.6 points (40 to 100), respectively. The mean total post-operative American Orthopaedic Foot and Ankle Society score in 21 patients was 89.7 points (72 to 100). We found a significant post-operative reduction in talar tilt and anterior drawer sign (chi-squared test, p <0.001). The functional outcome of the procedure was excellent in ten patients (48%), good in seven (33%) and fair in four (19%). The results in terms of ankle function and stability did not deteriorate with time and there was little restriction in movement. This procedure is simple and effective with a very low rate of complications.