The rate of chronic lateral ankle instability has increased in children and teenagers. However, studies concerning its management within this population are rare. Current repair techniques involve use of the peroneus brevis tendon. Here, we have described and evaluated a method utilizing a regional periosteal flap for reconstructing the lateral ligaments of the ankle.

After describing the technique, we conducted a single-center, retrospective study over a four-year period. For functional assessment, we used the American Orthopedic Foot and Ankle Societyy (AOFAS) score as well as Gould's criteria. For radiological assessment, we calculated the tibiotalar tilt and anterior translation of the talus.

A total of 14 children were included in this study. The mean age of patients was 12.7 years old, and the mean follow-up was 3.1 years. The mean AOFAS score evolved from 61 points (before surgery) to 95 points after surgery (P<0.001). Gould's classification revealed 11 excellent, 2 good, 1 average, and no bad outcomes. Also, surgical intervention led to evolution of the tibiotalar tilt from 14° to 4° (P<0.001), while the anterior translation of the talus went from 11mm to 2mm (P<0.001). The mean skeletal age was 12.5 years. No case of epiphysiodesis of the lateral malleolus or heterotopic bone was found.

It appears that non-anatomical reconstruction involving the peroneus brevis can be avoided in young patients. Due to the frequent impossibility of ligament suturing within this population, we have developed a reconstruction technique involving the use of a regional periosteal flap. Notably, in the case of recurrence, the patients’ peroneus brevis tendons remain intact for future procedures.

Repair involving the periosteal flap yields good clinical and radiological results. Our preliminary findings are encouraging and suggest that this technique should be evaluated in a larger patient population with long-term follow-up.

IV – retrospective study.