Acute repair and delayed reconstruction for lateral ankle instability: Twenty-year follow-up study

Objectives: To determine long-term results of patients who underwent primary ligament repair and delayed reconstruction for lateral ligament instability. Design: Retrospective. Setting: Outpatient clinic. Patients/Participants: Patients who had undergone acute repair or delayed reconstruction at this institution between 1958 and 1977, excluding patients who were deceased or who could not be located. Intervention: Forty-eight patients (fifty-three ankles) under-went twenty-two primary ligament repairs and thirty-one delayed reconstruction operations. Main Outcome Measurements: Clinical results graded with clinical scale and radiologic results based on stress radiographs and plain film radiographs. Results: At an average of twenty years after operation (range 12 to 33 years), patients were satisfied with forty-nine ankles, satisfied with reservations with two ankles, and dissatisfied with two ankles. Clinical results after repair were excellent in twenty ankles, good in one, fair in none, and poor in one. After reconstruction, the results were excellent in twenty-one ankles, good in six, fair in one, and poor in three. In the primary repair group, the mean talar tilt with stress testing improved from 20.7 ± 10.7 degrees before operation to 2.8 ± 3.0 degrees after operation. In the reconstruction group, the mean talar tilt improved from 20.7 ± 8.4 degrees before operation to 2.8 ± 3.5 degrees after operation. Conclusions: Clinical and radiologic results were similar in the repair and reconstruction groups. The majority of severe (Grade III) ankle sprains may be treated nonoperatively, but if residual instability occurs, late reconstruction should achieve satisfactory results.