*Essentials in Hip and Ankle*

have been compared. Excellent results were shown for both open and arthroscopic surgical procedures in the treatment of the chronic ankle instability. The higher complication rate of arthroscopic procedures relative to open ones represents a major issue; however, this does not seem to affect the patient's satisfaction [60].

*3.2.2 Graft reconstruction*

Using tendon grafts to reconstruct the medial or lateral ligaments is indicated

Numerous graft reconstruction techniques have been reported. They can be divided into roughly two types: anatomical and nonanatomical reconstruction.

CFL as anatomically as possible. The nonanatomical reconstruction, also called peroneus tenodesis, leads to nonphysiological intra-articular pressure peaks, sacrifices a dynamic stabilizer, and causes movement restrictions. It should therefore only be used when all other treatment options have failed [61]. Recent metaanalysis concluded that nonanatomical reconstruction may abnormally increase the

Anatomical reconstruction is intended to reproduce the course of the ATFL and

Numerous graft options have been reported including the plantaris longus tendon, hamstrings tendon, and bone-tendon-bone grafts [63–66]. These tendon grafts are fixed to the malleolus, talus, and calcaneus in various ways including the suture anchor, interference screw, and endo-button. The remnant ligaments are debrided or left in situ. There is still a lack of consensus as to which technique is biomechan-

Postoperative treatments of both suture repair and graft reconstruction are similar to that of acute ankle sprain. Recommendations according to the Cochrane

Ankle sprains are involved in up to 30% of all sport injuries with 30% of patients likely to develop CAI. These traumas can limit their professional or recreational activities significantly. The diagnosis of CAI is mainly clinically based. Sonography is cost-effective and allows real-time assessment of ligament integrity and laxity. Arthroscopic examination has the highest accuracy rate and allows direct visualiza-

Once conservative treatment has failed, surgery is indicated to restore ankle

arthroscopically if the remnant ligament quality is acceptable. Anatomical graft reconstruction is used if remnant quality is poor or a revision is required.

joint stability. Suture repair is satisfactory, whether performed open or

when local tissue quality is poor or in case of revision surgery.

inversion stiffness at the subtalar level [62].

*Diagnosis and Treatment of Chronic Ankle Instability DOI: http://dx.doi.org/10.5772/intechopen.89485*

ically stronger or gives better functional results.

tion of both ligaments and intra-articular lesions.

The authors declare no conflict of interest.

*3.2.3 Postoperative treatment*

**4. Conclusions**

**Conflict of interest**

**93**

review are listed in **Table 1** [67].

#### **Figure 7.**

*Arthroscopic all-inside repair of the ATFL using suture anchor. (a) Detached ATFL and periosteum from distal fibula along with an osseous fragment. (b) Complete detachment of an osseous fragment from the fibula. (c) Application of suture anchor to fibula tip after excision of osseous fragment. (d) Reattachment of the ATFL using a suture anchor.*


#### **Table 1.** *Postoperative treatment protocol.*

#### *3.2.2 Graft reconstruction*

have been compared. Excellent results were shown for both open and arthroscopic surgical procedures in the treatment of the chronic ankle instability. The higher complication rate of arthroscopic procedures relative to open ones represents a major issue; however, this does not seem to affect the patient's satisfaction [60].

*Arthroscopic all-inside repair of the ATFL using suture anchor. (a) Detached ATFL and periosteum from distal fibula along with an osseous fragment. (b) Complete detachment of an osseous fragment from the fibula. (c) Application of suture anchor to fibula tip after excision of osseous fragment. (d) Reattachment of the ATFL*

**Table 1.**

**92**

**Figure 7.**

*using a suture anchor.*

*Essentials in Hip and Ankle*

*Postoperative treatment protocol.*

Using tendon grafts to reconstruct the medial or lateral ligaments is indicated when local tissue quality is poor or in case of revision surgery.

Numerous graft reconstruction techniques have been reported. They can be divided into roughly two types: anatomical and nonanatomical reconstruction.

Anatomical reconstruction is intended to reproduce the course of the ATFL and CFL as anatomically as possible. The nonanatomical reconstruction, also called peroneus tenodesis, leads to nonphysiological intra-articular pressure peaks, sacrifices a dynamic stabilizer, and causes movement restrictions. It should therefore only be used when all other treatment options have failed [61]. Recent metaanalysis concluded that nonanatomical reconstruction may abnormally increase the inversion stiffness at the subtalar level [62].

Numerous graft options have been reported including the plantaris longus tendon, hamstrings tendon, and bone-tendon-bone grafts [63–66]. These tendon grafts are fixed to the malleolus, talus, and calcaneus in various ways including the suture anchor, interference screw, and endo-button. The remnant ligaments are debrided or left in situ. There is still a lack of consensus as to which technique is biomechanically stronger or gives better functional results.

#### *3.2.3 Postoperative treatment*

Postoperative treatments of both suture repair and graft reconstruction are similar to that of acute ankle sprain. Recommendations according to the Cochrane review are listed in **Table 1** [67].
