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Anatomical, minimally invasive lateral ankle ligamentoplasty using gracilis: the ankle lateral ligamentoplasty (ALL) technique

Published in N°274 - May 2018
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Anatomical, minimally invasive lateral ankle ligamentoplasty using gracilis: the ankle lateral ligamentoplasty (ALL) technique

By Michel BENICHOU (1), Yannick ROUSSANNE (1), Jérôme DILIGENT (2) , Didier VIEJO (3) in category TECHNIQUE
(1) - Polyclinique Saint-Roch, 560 Avenue du Colonel André Pavelet - Montpellier / (2) - Centre Chirurgical ADR - 6 rue Colette - 54000 Nancy / (3) - Centre hospitalier d’Agen, Route de Villeneuve sur Lot, Saint-Esprit - Agen

Lateral ankle sprains are the most common joint injury, the incidence being estimated as approaching 1/10,000 people per day: that is, about 6,000 sprains per day in France.
Chronic lateral ankle instability is a common sequela, complicating between 5 and 20% of sprains. It carries a long-term progressive risk of arthrosis of the tibiotalar joint.

Introduction

Lateral ankle sprains are the most common joint injury, the incidence being estimated as approaching 1/10,000 people per day (1): that is, about 6,000 sprains per day in France (2).

Chronic lateral ankle instability is a common sequela, complicating between 5 and 20% of sprains. It carries a long-term progressive risk of arthrosis of the tibiotalar joint (3).

Primary treatment of the instability is medical and includes physiotherapy combined with correction of any static issues. If these are not successful, surgical stabilization of the talocrural joint may be offered. Surgical techniques are classified according to the principle on which the repair is based (4), either capsuloligamentous retensioning alone or in association with reinforcement, and substitution techniques using the periosteum, a para-articular tendon or hemitendon, or a free graft (gracilis, semitendinosus, plantaris, hemi-peroneus brevis, peroneus tertius and so on). The various surgical techniques achieve relatively satisfactory early outcomes in terms of ankle stability. However, non-anatomical techniques have demonstrated long-term inadequacy, giving rise to progressive distension of ligamentoplasties and progression of arthrosis.

The ALL surgical technique is a minimally invasive, anatomical...

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