Associated injuries found in chronic lateral ankle instability

Sixty-one patients underwent a primary ankle lateral ligament reconstructio n for chronic instability between 1989 and 1996. In addition to the ligamen t reconstruction, all patients had evaluation of the peroneal retinaculum, peroneal tendon inspection by routine opening of the tendon sheath, and ank le joint inspection by arthrotomy. A retrospective review of the clinical h istory, physical exam, MRI examination, and intraoperative findings was con ducted on these 61 patients. The purpose was to determine the type and freq uency of associated injuries found at surgery and during the preoperative e valuation, At surgery no patients were found to have isolated lateral ligam ent injury. Fifteen different associated injuries were noted. The injuries found most often by direct inspection included: peroneal tenosynovitis, 47/ 61 patients (77%); anterolateral impingement lesion, 41/61 (67%); attenuate d peroneal retinaculum, 33/61 (54%); and ankle synovitis, 30/61 (49%). Othe r less common but significant associated injuries included: intra-articular loose body, 16/61 (26%); peroneus brevis tear, 15/61 (25%); talus osteocho ndral lesion, 14/61 (23%); medial ankle tendon tenosynovitis, 3/61 (5%). Th e findings of this study indicate there Is a high frequency of associated i njuries in patients with chronic lateral ankle instability, Peroneal tendon and retinacular pathology, as well as anterolateral impingement lesions, o ccur most often, A high index of suspicion for possible associated injuries may result in more consistent outcomes with nonoperative and operative tre atment of patients with chronic lateral ankle instability.