Anatomic reconstruction of lateral ankle ligaments: is there an optimal graft option?

Pietro Spennacchio, Romain Seil, Caroline Mouton, Sebastian Scheidt, Davide Cucchi*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose: Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories: allografts and autografts. This study aims to provide an updated comparison of the clinical outcomes after stabilisation procedures using allografts and autografts, to correctly advise the clinician during the choice of the best material to be used for the reconstruction of the lateral ligamentous complex of the ankle. Methods: A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient’s subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures. Results: Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes. Conclusions: The systematic analysis of validated CAI outcome measures and the patient’s subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson–Peterson score superior to 80 points and to a similar rate of patient’s subjective satisfaction. Level of evidence: Level IV.

Original languageEnglish
Pages (from-to)4214-4224
Number of pages11
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume30
Issue number12
Early online date2 Aug 2022
DOIs
Publication statusPublished - Dec 2022

Keywords

  • Allograft
  • Ankle ligament reconstruction
  • Autograft
  • Chronic ankle instability
  • Karlsson score
  • Satisfaction
  • Validated outcome

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