Autotendoplasty using the palmaris longus tendon for chronic anterolateral ankle instability: a clinical series (n = 27)

Objective . To evaluate an implant-independent stabilization method for chronic anterolateral ankle instability using a palmaris longus tendon autograft. Materials and methods. A clinical series of 27 patients treated in 2022–2025 was analyzed. The method included two-mini-incision palmaris longus harvesting, fibular tunnel formation in a superior-inferior and anteriorposterior direction, graft passage as a loop and transosseous fixation to the lateral talar surface without anchors or screws. Outcomes were assessed with AOFAS, Karlsson-Peterson, FAAM-ADL, FAAM-Sport and VAS pain scores at 6, 12 and 24 months. Results . AOFAS improved from 63.2 ± 6.4 preoperatively to 89.1 ± 4.7 at 12 months and 90.0 ± 4.5 at 24 months. Karlsson–Peterson improved from 51.8 ± 6.8 to 86.7 ± 5.6 and 87.5 ± 5.4, FAAM-ADL from 59.4 ± 8.1 % to 89.2 ± 5.9 % and 90.3 ± 5.6 %, FAAM-Sport from 54.8 ± 9.2 % to 87.3 ± 6.4 % and 88.2 ± 6.2 %, while VAS pain decreased from 6.4 ± 1.2 to 1.4 ± 0.8 and 1.3 ± 0.7. Return to activity was achieved in 24/27 patients (88.9 %) at 12 months and 25/27 (92.6 %) at 24 months. No revision surgery, common peroneal nerve injury or clinically significant donor-hand deficit was recorded. Conclusion . The palmaris longus method appears to be a reproducible option for chronic anterolateral ankle instability when local ligament tissue is insufficient and preservation of peroneal tendons is required.