Modified Evans technique for treatment of chronic lateral ankle instability

Background
Chronic ankle ligamentous instability is not uncommonly encountered condition after severe ankle sprains. A number of operative procedures have been developed and described in the literature, including variations on the original Evans tenodesis. The aim of this study was to propose a modification to the original Evans procedure that includes surgical tips and rigid fixation of the rerouted peroneus brevis tendon.
Patients and methods
Ten patients with chronic lateral ankle ligamentous instability were operated upon with a new technique that represents a modified Evans tenodesis. In this technique, rigid fixation of the rerouted peroneus brevis tendon was achieved by securing the tendon through transverse tunnel 1 cm proximal to the tendon outlet.
Results
All patients in this study reported good to excellent functional outcome. The mean Karlsson score at 1-year follow-up showed a statistically significant increase from a preoperative mean of 61 ± 3.94 SD to a mean of 88.2 ± 3.97 SD. Tegner activity level showed a significant increase from a preoperative mean of 3.3 ± 0.82 SD to a mean of 6.1 ± 0.57 SD.
Conclusion
The proposed modification on the Evans procedure has shown clinical efficacy in patients with chronic lateral ankle instability. Secure tendon fixation allowed for early cast removal and faster rehabilitation, with subsequent early return to functional activities.