INTRODUCTION: The authors present the results of a surgical technique for lateral ankle chronic instability, derived from Castaing and Duquennoy procedures. It uses a half peroneus brevis with a tightening of the antero- lateral capsule. A Plasty with the extensorum digitorum brevis was used in the event of associated subtalar instability.

MATERIAL AND METHODS: Between 2001 and 2005, 38 cases of ligamentoplasties have been performed for chronic instability of the ankle. 32 (25 men and 7 women) of them have been reviewed with a mean delay of 26 months (extremes of 10 months to 5 years). They were middle-aged of 28,5 years. All the patients have been reviewed with stress X-Ray in varus of the both ankles (measure of tibio talar angle, arthritis) and had a strength measure in eversion by the same examiner. The functional evaluation was performed with Molander and Olerud ankle score.

RESULTS: There were 20% of complications, especially cutaneous cicatrisation problems and algodystrophy. After surgery, no patient had instability; only one, had apprehension of the ankle. 90 % retrieved the same sport with the same level. No body changed of job. 3 patients were disappointed because of pain in sports and stiffness. At revision, the functional score was 90 against 59 at the pre operative time. The difference of strength in eversion between the two ankles was about 7%. Laxity had a good correction seeing the average tibio talar angle between the both ankle is 0,5°.

DISCUSSION: The results of this procedure show a distinct improvement of stability, radiological laxity and functional activity. The arthrotomy performed in Duquennoy procedure, is useful for diagnosis and treatment. It shows the cartilage and allows the removal of impingement and foreign bodies. A plasty that uses the single evertor deprives the ankle of a part of active and proprioceptive control. However, the patients didn’t feel a difference or a discomfort. The patients who had the surgery on the jump foot side had no significative difference of strength in eversion between the both ankles.

CONCLUSION: This anatomical procedure gives 91% of satisfaction, for these active young people. The postoperative physiotherapy allows the complete recovery of activities from the sixth month after surgery.

Purpose: Autologous osteochondral grafts using the Mosaicplasty(r) technique have been employed for more then a decade for the treatment of osteocartilaginous tissue loss in weight-bearing zones. The advantage is to repair damage using a hyaline cartilage. Application of this technique to the talar dome is more recent and has been inspired by the good results obtained at the knee level. The purpose of this retrospective analysis was to determine outcome in 36 patients presenting tissue loss of the talar dome who underwent surgery between June 1997 and September 2001 using the method described by L. Hangody and to determine the contribution of the malleolar osteotomy.

Material and methods: Patients, aged 17 to 53 years, complaining of ankle problems were managed in three centres. Surgery was performed by three senior surgeons experienced with knee Mosaicplasty(r). The Acufex Mosaicplasty(r) instrumentation furnished by Smith-Nephew was used in all cases. The ankle was rarely opened by direct arthrotomy. Osteotomy of the medial or lateral malleolus was preferred. Bone grafts were harvested, with the patient’s consent, from a non-weight-bearing articular zone of the homolateral knee. The International Cartilage Repair Society (ICRS) chart, modified for the ankle, was used to assess outcome. Epi-Info 6.0 was used for statistical analysis.

Results: The deep lesions were all ICRS grade III or IV and involved dissecting osteochondritis (n=21), chondral or osteochondral avulsion (n=13) and dome necrosis (n=2). Osteotomy of the medial malleolus was required to access the lesions in 27 ankles; a lateral osteotomy was used in six ankles. After a mean follow-up of 18 months, outcome was considered excellent or good in 81% (ICRS grade I and II). Mild knee pain was reported by 14 patients. All malleolar osteotomies healed without complication. None of the cases worsened.

Discussion: This technique is to be reserved for young symptomatic patients. Despite the more traumatic technique compared with the traditional method, Mosaicplasty(r) enables repair with hyaline cartilage giving more satisfactory short- and mid-term results. Use of a medial or lateral osteotomy does not create any major problem. This is the only was to obtain good lesion exposure, particularly for more posterior lesions. Morbidity at the donor site, though not significantly proven in this series, should be examined in more detail.

Conclusion: Autologous osteochondral grafts using Mosaicplasty(r) is a validated technique for ankle repair. Malleolar osteotomy has been found to be important to achieve proper repair. A long-term study will be needed to evaluate the persistence of these results, and possible donor site morbidity, as well as the preventive effect against osteoarthritis.