Autograft Choice for Anatomic Reconstruction of Lateral Ankle Ligaments in Chronic Ankle Instability: A Systematic Review

Anatomic reconstruction of the lateral ligamentous ankle complex with an autograft is indicated as a surgical approach in chronic ankle instability management. This approach benefits ankles deficient in ligamentous support and those with greater occupational or sporting demands. Autograft choice varies in clinical practice and is driven by surgeon’s choice and patient-specific ankle demands. Current literature does not favor any particular autograft with respect to functional outcomes or postoperative complications. This review systematically compares common autografts through patient-reported outcome measurements (PROMs) and radiographic assessments. A literature search was performed using Ovid MEDLINE and PubMed databases. Studies were screened against inclusion and exclusion criteria and selected studies were critically appraised using Mixed Methods Appraisal Tool 2018. Preoperative and postoperative values of PROMs and radiographic outcomes were extracted, and the percentage change indicated intervention effectiveness. One-way analysis of variance was used to ascertain any statistical significance between the autografts. A total of 20 studies were included comprising 734 patients and 738 ankles. Six different autografts (gracilis, extensor digitorum longus, bone-patellar tendon, semitendinosus, anterior half of peroneus longus, and anterior half of peroneus brevis), 3 PROMs (the American Orthopaedic Foot and Ankle Score, visual analog scale, and Karlsson-Peterson scale), and 2 radiographic assessments (anterior talar translation and talar tilt) were analyzed. Peroneal tendons showed superior PROMs and radiographic assessments, though not statistically significant, with also the lowest complication rates. Autografts with a distal harvest sites, such as gracilis or bone-patellar tendon-bone, carry higher risks of harvest-related and nerve injuries compared with other autografts.