The Anatomic Reconstruction for Chronic Lateral Ankle Instability Utilizing Absorbable Synthetic Graft (ATLAS Procedure): Description and Short Term Follow Up

Abstract

Category: Ankle Introduction/Purpose: The traditional modified Brostrom-Gould has long been the procedure of choice for addressing chronic lateral ankle instability. However, more robust techniques including anatomic reconstruction are favored for larger deformity, poor tissue quality and revision surgery. Given the inherent disadvantages of allograft and non-elastic synthetic materials, material science has sought to impact the graft choice providing alternative load sharing, permeable materials with high strength. Our institution has performed anatomic lateral ligament stabilization, termed the 'ATLAS' procedure, using a novel synthetic graft (Artelon, Marietta, GA) with anecdotal success in recent years. In this study, we present our surgical technique and early experience. Methods: A retrospective cohort review was performed, evaluating the failure rate, complications and radiographic changes in anatomic alignment. A review of all patients undergoing the ATLAS procedure was performed, a total of 27 patients were included. The study included only those patients with at least 1 year follow up from the procedure. Results: Only one patient had symptoms of early failure of the procedure, while none of the patients required a revision procedure. The most common complication was minor wound dehiscence (11.1%). Overall, our short-term results with this procedure were excellent. Conclusion: We conclude that the ATLAS procedure is a predictable and effective lateral ligament reconstruction technique with no donor site morbidity, no donor tissue transmission risk, low risk of over-constraint and accomplished with a predictable technique.