Anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a 2-to 10-year follow-up, multicenter study

The clinical outcome of anatomical reconstruction or tenodesis in the treat ment of chronic anterolateral ankle instability was assessed in a retrospec tive multicenter study. The anatomical reconstruction group (group A) consi sted of 106 patients (mean age at operation 24 +/- 8.4 years) and the tenod esis group (group B) of 110 patients (mean age at operation 26 +/- 11.4 yea rs). Patients were evaluated at a mean follow-up of 5.5 +/- 2.8 years in gr oup A and 5.2 +/- 2.9 years in group B. The review protocol included patien t characteristics, physical examination, two ankle scoring scales to evalua te the functional results, and standard anteroposterior and lateral radiogr aphs to evaluate degenerative changes. Mechanical stability was evaluated u sing standardized stress radiographs. A larger number of re operations was performed in group B (P = 0.008). At physical examination, more patients in group B had a smaller range of ankle motion than those in group A (P = 0.0 09). A larger proportion of patients in group B had medially located osteop hytes, as seen on standard radiographs (P = 0.04). On stress radiographic e xamination, the mean talar tilt (P = 0.001) and mean anterior talar transla tion (P < 0.001) were seen to be significantly greater in group B than in g roup A. There were no differences in mean Karlsson score between the groups , but more patients in group A had an excellent result on the Good score (P = 0.011). Unlike anatomical reconstructions, tenodeses do not restore the normal anatomy of the lateral ankle ligaments. This results in restricted r ange of ankle motion, reduced long-term stability, an increased risk of med ially located degenerative changes, a larger number of reoperations, and le ss satisfactory overall results.