Anatomic reconstruction of the lateral ligament of the ankle using a periosteal flap from the fibula

Ken Okazaki, Satoshi Miyagi, Junichi Tokunaga

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15 Citations (Scopus)


Rupture of lateral ligaments of the ankle is a common injury and sometimes requires surgical treatment. The condition of the torn ligaments is sometimes too poor to be repaired, particularly in cases of chronic instability or recurrent injury, but it is difficult to predict the exact condition preoperatively, and surgeons may need to change the procedure based on the findings during the operation. Reconstruction of the lateral ligament using a periosteal flap of the fibula is a simple and safe method. A periosteal flap is made on the lateral malleolus, and the flap is turned over from the proximal to the distal, overlying the repaired ligaments. Clinical results were assessed in 13 cases using stress x-ray, and a scoring system designed by the American Orthopaedic Foot and Ankle Society (AOFAS) was used before the operation and at follow-up. The mean talar tilt angle on stress x-ray was 19.8 degrees before the operation and 8.5 degrees at follow-up. There was no limitation in range of motion at follow-up. The mean clinical score of the AOFAS was 97.2 points at follow-up. All athletic patients returned to the same sports activities within 6 months. Biopsy of the reconstructed ligament was performed in a patient 12 months after the surgery. Histological examination of the reconstructed ligament suggested transformation of the periosteum to ligamentous tissue. Reconstruction with a periosteal flap is a simple, safe, and reliable method that allows anatomic reconstruction for chronic injuries as well as reinforcement of the primary repair of the lateral ligaments of the ankle.

Original languageEnglish
Pages (from-to)98-103
Number of pages6
JournalTechniques in Foot and Ankle Surgery
Issue number2
Publication statusPublished - 2005
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine


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