Comparative analysis of anatomic and non-anatomic methods of ligament reconstruction for chronic anterlolateral ankle instability

Objective. To compare the clinical outcomes of anatomical and non-anatomical (modified Chrisman-Snook with peroneus brevis muscle splitting) methods of anterolateral ligament complex reconstruction for chronic ankle instability (CAI) to determine preferred treatment strategy depending on the time from initial injury.

Materials and methods. The study included 44 patients who underwent inpatient surgical treatment at the 2nd Traumatology Department of the State Institution «432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus» from January 2020 to June 2025. The study sample consisted of 32 men and 12 women, aged from 18 to 64 years. Twenty-nine patients underwent anatomical reconstruction of the anterolateral ligament complex of the ankle (Broström/ Broström-Gould), while the remaining 15 patients underwent non-anatomical reconstruction using a modified Chrisman-Snook technique with splitting of the m. peroneus brevis tendon. All patients underwent preoperative clinical testing (anterior drawer test, talar tilt test), stress radiography, ankle MRI, and a standardized questionnaire (Appendix 1). All surgeries were performed under spinal anesthesia and tourniquet applied just below a knee. The average hospital stay was 6 days. Early postoperative immobilization consisted of wearing a posterior plaster cast on the lower leg for 3 weeks, which was then replaced with an elastic orthosis for the next 3 weeks with gradual reinstatement of range of motion. During outpatient treatment, patients took nonsteroidal anti-inflammatory drugs (NSAIDs), venotonics, and chondroprotectors. Eight to nine weeks after surgery, intra-articular hyaluronic acid injections were administered in a course of three injections each 7–10 days. Clinical outcomes were assessed using the AOFAS scale.

Results. AOFAS score results: 65 ± 8 points before surgery, 90 ± 5 points after surgery (after 12 months). The proportion of the patient’s full-fledged return to work and sports activities is 92.6 % and 86.7 ± 8.8 %, respectively. At 3, 6, and 12 months after surgery, most patients showed a restoration of stability and an improvement in their subjective assessment. Anatomical techniques (Broström / Broström-Gould) gave the best results with fresh injuries, non-anatomical (modified Chrisman-Snook) – with old ones. The follow-up protocol, questionnaire, and rehabilitation algorithm contributed to good clinical outcomes.

Conclusion. For injuries < 12 months old, anatomical reconstruction of the anterolateral ligament complex of the ankle (Broström/Broström-Gould) is advisable as a method, preserving proprioception and joint biomechanics. For long-standing injuries (>12 months), non-anatomical reconstructions (modified Chrisman-Snook) are justified. Both approaches, with adequate diagnostics, rational determination of surgical indications, precise adherence to the, and according rehabilitation protocol, provide good clinical outcomes.

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