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Arthroscopic all-inside ATFL and CFL repair is feasible and provides excellent results in patients with chronic ankle instability

  • ANKLE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Chronic ankle instability has been described as presenting with complete tears of both the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in 20% of cases. Arthroscopic techniques to treat chronic ankle instability are increasingly being reported and in some instances they can be technically demanding. The aim of this study was to describe an arthroscopic all-inside repair of both the ATFL and CFL, and to report the outcomes of a group of patients with chronic ankle instability that underwent the technique.

Methods

Twenty-four patients [22 male and 2 female, median age 41 (range 22–56) years] with chronic ankle instability and torn ATFL and CFL were treated arthroscopically after failing non-operative management. Median follow-up was 35 (mean 34.7, and range 18–55) months. Through an arthroscopic all-inside technique, and using a suture passer and two knotless anchors, both fascicles of the ATFL and the CFL were repaired.

Results

Arthroscopic examination demonstrated ATFL and CFL injuries in all patients. Subjective improvement in their ankle instability was observed postoperatively. The anterior drawer and the talar tilt tests were negative at follow-up. The median AOFAS score increased from 65 (mean 65, range 52–85) preoperatively to 97 (mean 97, range 85–100) at final follow-up.

Conclusion

Chronic ankle instability with concomitant injury of both the ATFL and CFL, can be successfully treated by an arthroscopic all-inside repair. The clinical relevance of the study is the description of the first arthroscopic all-inside ATFL and CFL anatomic repair technique, which offers excellent clinical results and the inherent benefits from minimally invasive surgery.

Level of evidence

IV, retrospective case series.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain

    Jordi Vega & Miki Dalmau-Pastor

  2. Foot and Ankle Unit, iMove Traumatología Clínica Tres Torres, Hospital Quirón Barcelona, Plaza Alfonso Comín 5, 08023, Barcelona, Spain

    Jordi Vega

  3. GRECMIP (Groupe de Recherche et d’Etude en Chirurgie Mini-Invasive du Pied) Soon MIFAS (Minimally Invasive Foot and Ankle Society), Merignac, France

    Jordi Vega

  4. Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK

    Francesc Malagelada

  5. Vilamèdic, Santa Coloma de Gramanet, Barcelona, Spain

    Miki Dalmau-Pastor

Authors
  1. Jordi Vega
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  2. Francesc Malagelada
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  3. Miki Dalmau-Pastor
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Correspondence to Jordi Vega.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethical committee of the institution.

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Patients were informed, and they consented to conduct the study.

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Vega, J., Malagelada, F. & Dalmau-Pastor, M. Arthroscopic all-inside ATFL and CFL repair is feasible and provides excellent results in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 28, 116–123 (2020). https://doi.org/10.1007/s00167-019-05676-z

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  • DOI: https://doi.org/10.1007/s00167-019-05676-z

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