Skip to main content
SpringerLink
Log in

Arthroscopic all-inside ligament repair has similar or superior clinical outcomes compared to open repair for chronic ankle instability without concomitant intra-articular pathology at 5 years follow-up

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

Abstract

Purpose

Open ligament repair is widely considered the gold standard treatment for chronic ankle instability. Nevertheless, arthroscopic treatment of ankle instability has gained popularity becoming the preferred technique for many surgeons. This study aimed to compare the clinical outcomes of all-inside arthroscopic versus open lateral ligament repair for chronic ankle instability at 5 years follow-up.

Methods

Ninety consecutive patients were surgically treated for chronic ankle instability without concomitant intra-articular pathology observed on MRI: 41 patients [median age 28 (range 15–54) years] underwent an open lateral ligament repair (OLR); 49 patients [median age 30 (range 19–47) years] underwent an all-inside arthroscopic ligament repair (ALR). Functional outcomes using the Foot Functional Index (FFI), the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Score, and the Foot and Ankle Ability Measure-Sports Subscale (FAAM-SS) were assessed preoperatively and at the latest follow-up. At the latest follow-up, the satisfaction rate and complications were also recorded.

Results

The mean follow-up was 58 ± 17.6 (range 47–81) months. In both groups FFI, AOFAS and FAAM-SS score significantly improved compared to preoperative values (p < 0.001). There was no statistically significant difference in postoperative outcomes between groups in the AOFAS (n.s) and FAAM-SS (n.s), but the FFI results were significantly better in the ALR group (p < 0.05). No major complications were reported in either group.

Conclusion

Open and arthroscopic ligament repair to treat chronic ankle instability without concomitant intra-articular pathology produced excellent comparable clinical outcomes at 5 years follow-up. The complications were minimal in both study groups with no significant differences in AOFAS and FAAM-SS scores. However, arthroscopic repair showed significantly better results on the FFI. Therefore, when treating chronic lateral ankle instability, surgeons should consider arthroscopic ligament repair.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

References

  1. Acevedo JI, Ortiz C, Golanó P, Nery C (2015) ArthroBrostrom lateral ankle stabilization technique: an anatomic study. Am J Sports Med 43:2564–2571

    Article  PubMed  Google Scholar 

  2. Amri MI, Alzhrani MM, Alanazi AD, Alqahtani MM, Kashoo FZ (2022) Cross-cultural adaptation and validation of the Arabic version of the foot function index in patients with chronic lateral ankle instability. J Foot Ankle Res 15:21. https://doi.org/10.1186/s13047-022-00527-6

    Article  PubMed  PubMed Central  Google Scholar 

  3. Baek JH, Kim JH, Jeong BO (2023) Arthroscopic Broström-Gould repair has comparable radiological and clinical outcomes compared to traditional open Broström-Gould repair in high-demand patients. Knee Surg Sports Traumatol Arthrosc 31:2208–2215

    Article  PubMed  Google Scholar 

  4. Brown AJ, Shimozono Y, Hurley ET, Kennedy JG (2018) Arthroscopic repair of lateral ankle ligament for chronic lateral ankle instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 34:2497–2503

    Google Scholar 

  5. Comfort SM, Marchetti DC, Duncan PP, Dornan GJ, Haytmanek CT, Clanton TO (2023) Broström repair with and without augmentation: comparison of outcomes at median follow-up of 5 years. Foot Ankle Int 44:691–701

    Article  PubMed  Google Scholar 

  6. Cottom JM, Acevedo J, Sisovsky CS (2023) Medium-term outcomes of the arthroscopic Brostrom procedure: a retrospective analysis of 66 patients. J Foot Ankle Surg. https://doi.org/10.1053/j.jfas.2023.09.001

    Article  PubMed  Google Scholar 

  7. Dias S, Lewis TL, Alkhalfan Y, Ahluwalia R, Ray R (2022) Current concepts in the surgical management of chronic ankle lateral ligament instability. J Orthop 33:87–94

    Article  PubMed  PubMed Central  Google Scholar 

  8. DiGiovanni BF, Partal G, Baumhauer JF (2004) Acute ankle injury and chronic lateral instability in the athlete. Clin Sports Med 23:1–19

    Article  PubMed  Google Scholar 

  9. DiGiovanni CW, Brodsky A (2006) Current concepts: lateral ankle instability. Foot ankle Int 27:854–866

    Article  PubMed  Google Scholar 

  10. van Dijk CN, Bossuyt PM, Marti RK (1996) Medial ankle pain after lateral ligament rupture. J Bone Jt Surg Br 78:562–567

    Article  Google Scholar 

  11. Drakos M, Hansen O, Kukadia S (2022) Ankle instability. Foot Ankle Clin 27:371–384

    Article  PubMed  Google Scholar 

  12. Feng SM, Sun QQ, Chen J, Gao SH, Oliva F, Maffulli N (2023) One double-loaded suture anchor is sufficient for all-inside arthroscopic anterior talofibular ligament repair. Knee Surg Sports Traumatol Arthrosc 31:3500–3508

    Article  PubMed  Google Scholar 

  13. Ferkel RD, Chams RN (2007) Chronic lateral instability: arthroscopic findings and long-term results. Foot Ankle Int 28:24–31

    Article  PubMed  Google Scholar 

  14. Ferran NA, Maffulli N (2006) Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin 11:659–662

    Article  PubMed  Google Scholar 

  15. Guelfi M, Nunes GA, Malagelada F, Cordier G, Dalmau-Pastor M, Vega J (2020) Arthroscopic-assisted versus all-arthroscopic ankle stabilization technique. Foot Ankle Int 41:1360–1367

    Article  PubMed  Google Scholar 

  16. Guelfi M, Vega J, Malagelada F, Dalmau-Pastor M (2020) The arthroscopic all-inside ankle lateral collateral ligament repair is a safe and reproducible technique. Knee Surg Sports Traumatol Arthrosc 28:63–69

    Article  PubMed  Google Scholar 

  17. Guelfi M, Zamperetti M, Pantalone A, Usuelli FG, Salini V, Oliva XM (2018) Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability: a systematic review. Foot Ankle Surg 24:11–18

    Article  PubMed  Google Scholar 

  18. Guo H, Chen B, Chen Z, Sun N, Ji G, Zeng C (2023) The lasso-loop technique is equivalent to the simple suture technique in arthroscopic anterior talofibular ligament repair. Knee Surg Sports Traumatol Arthrosc 31:2174–2182

    Article  PubMed  Google Scholar 

  19. Hintermann B, Boss AP, Schäfer D (2002) Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med 30:402–409

    Article  PubMed  Google Scholar 

  20. Hong CC, Calder J (2022) Ability to return to sports after early lateral ligament repair of the ankle in 147 elite athletes. Knee Surg Sports Traumatol Arthrosc 31:4519–4525

    Article  PubMed  Google Scholar 

  21. Hung M, Baumhauer JF, Licari F, Voss M, Bounsanga J, Saltzman CL (2019) PROMIS and FAAM minimal clinically important differences in foot and ankle orthopedics. Foot Ankle Int 40:65–73

    Article  PubMed  Google Scholar 

  22. Komenda GA, Ferkel RD (1999) Arthroscopic findings associated with the unstable ankle. Foot Ankle Int 20:708–713

    Article  CAS  PubMed  Google Scholar 

  23. Li X, Killie H, Guerrero P, Busconi BD (2009) Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Broström repair using suture anchors. Am J Sports Med 37:488–494

    Article  PubMed  Google Scholar 

  24. Maffulli N, Del Buono A, Maffulli GD, Oliva F, Testa V, Capasso G, Denaro V (2013) Isolated anterior talofibular ligament Brostrom repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med 41:858–864

    Article  PubMed  Google Scholar 

  25. Matsui K, Takao M, Miyamoto W, Innami K, Matsushita T (2014) Arthroscopic Broström repair with Gould augmentation via an accessory anterolateral port for lateral instability of the ankle. Arch Orthop Trauma Surg 134:1461–1467

    Article  PubMed  Google Scholar 

  26. Messer TM, Cummins CA, Ahn J, Kelikian AS (2000) Outcome of the modified Brostrom procedure for chronic lateral ankle instability using suture anchors. Foot Ankle Int 21:996–1003

    Article  CAS  PubMed  Google Scholar 

  27. Michels F, Pereira H, Calder J, Matricali G, Glazebrook M, Guillo S, Karlsson J, Acevedo J, Batista J, Bauer T, Calder J, Carreira D, Choi W, Corte-real N, Glazebrook M, Ghorbani A, Giza E, Guillo S, Hunt K, Karlsson J, Kong SW, Lee JW, Michels F, Molloy A, Mangone P, Matsui K, Nery C, Ozeki S, Pearce C, Pereira H, Perera A, Pijnenburg B, Raduan F, Stone J, Takao M, Tourné Y, Vega J (2018) Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert. Knee Surg Sports Traumatol Arthrosc 26:2095–2102

    Article  PubMed  Google Scholar 

  28. Pinsker E, Daniels TR (2011) AOFAS position statement regarding the future of the AOFAS clinical rating systems. Foot Ankle Int 32:841–842

    Article  PubMed  Google Scholar 

  29. Schmidt R, Benesch S, Friemert B, Herbst A, Claes L, Gerngross H (2005) Anatomical repair of lateral ligaments in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 13:231–237

    Article  CAS  PubMed  Google Scholar 

  30. Takao M, Matsui K, Stone JW, Glazebrook MA, Kennedy JG, Guillo S, Calder JD, Karlsson J (2016) Arthroscopic anterior talofibular ligament repair for lateral instability of the ankle. Knee Surg Sports Traumatol Arthrosc 24:1003–1006

    Article  PubMed  Google Scholar 

  31. Thes A, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Elkaim M, Boniface O, Guillo S, Bauer T, Lopes R (2023) Five-year clinical follow-up of arthroscopically treated chronic ankle instability. Orthop Traumatol Surg Res 24:103649. https://doi.org/10.1016/j.otsr.2018.09.004

    Article  Google Scholar 

  32. Vega J, Allmendinger J, Malagelada F, Guelfi M, Dalmau-Pastor M (2020) Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability. Knee Surg Sports Traumatol Arthrosc 28:132–140

    Article  PubMed  Google Scholar 

  33. Vega J, Dalmau-Pastor M (2021) Editorial commentary: arthroscopic treatment of ankle instability is the emerging gold standard. Arthroscopy 37:280–281

    Article  PubMed  Google Scholar 

  34. Vega J, Dalmau-Pastor M, Malagelada F, Fargues-Polo B, Peña F (2017) Ankle arthroscopy: an update. J Bone Jt Surg Am 99:1395–1407

    Article  Google Scholar 

  35. Vega J, Golanó P, Pellegrino A, Rabat E, Peña F (2013) All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique. Foot Ankle Int 34:1701–1709

    Article  PubMed  Google Scholar 

  36. Vega J, Guelfi M, Malagelada F, Peña F, Dalmau-Pastor M (2018) Arthroscopic all-Inside anterior talofibular ligament repair through a three-portal and no-ankle-distraction technique. JBJS Essent Surg Tech 8:1–11. https://doi.org/10.2106/JBJS.ST.18.00026

    Article  Google Scholar 

  37. Vega J, Malagelada F, Dalmau-Pastor M (2020) 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

    Article  PubMed  Google Scholar 

  38. White WJ, McCollum GA, Calder JDF (2016) Return to sport following acute lateral ligament repair of the ankle in professional athletes. Knee Surg Sports Traumatol Arthrosc 24:1124–1129

    Article  PubMed  Google Scholar 

  39. Woo BJ, Lai MC, Koo K (2020) Arthroscopic versus open Broström-Gould repair for chronic ankle instability. Foot Ankle Int 41:647–653

    Article  PubMed  Google Scholar 

  40. Zeng G, Hu X, Liu W, Qiu X, Yang T, Li C, Song W (2020) Open Broström-Gould repair vs arthroscopic anatomical repair of the anterior talofibular ligament for chronic lateral ankle instability. Foot Ankle Int 41:44–49

    Article  PubMed  Google Scholar 

  41. Zhi X, Zhang Y, Li W, Wang Y, Zou Y, Lu L, Kong C, Xu D, Zhu Y, Wei S (2022) Absorbable suture anchor and knotless anchor techniques produced similar outcomes in arthroscopic anterior talofibular ligament repair. Knee Surg Sports Traumatol Arthrosc 30:2158–2165

    Article  PubMed  Google Scholar 

Download references

Funding

This study received no specific funding or grant.

Author information

Authors and Affiliations

  1. Foot and Ankle Unit, Casa di Cura Villa Montallegro, Genoa, Italy

    Matteo Guelfi

  2. Department of Orthopaedic Surgery “Gruppo Policlinico Di Monza”, Clinica Salus, Alessandria, Italy

    Matteo Guelfi

  3. Foot and Ankle Department, Clinique Montchoisi, Lausanne, Switzerland

    Rayan Baalbaki

  4. Foot and Ankle Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK

    Francesc Malagelada

  5. MIFAS By GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France

    Miki Dalmau-Pastor & Jordi Vega

  6. Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain

    Miki Dalmau-Pastor & Jordi Vega

  7. Foot and Ankle Unit, Hospital Quirón, Barcelona, Spain

    Jordi Vega

  8. iMove Traumatology Tres Torres, Barcelona, Spain

    Jordi Vega

Authors
  1. Matteo Guelfi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rayan Baalbaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesc Malagelada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miki Dalmau-Pastor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jordi Vega
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection and analysis were performed by: MG, RB, FM, MD and JV. MG wrote the first draft of the manuscript, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Matteo Guelfi.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

This study was approved by the ethical committee of the Hospital Quirón Barcelona with IRB number 00003099.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guelfi, M., Baalbaki, R., Malagelada, F. et al. Arthroscopic all-inside ligament repair has similar or superior clinical outcomes compared to open repair for chronic ankle instability without concomitant intra-articular pathology at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc 31, 6052–6058 (2023). https://doi.org/10.1007/s00167-023-07621-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-023-07621-7

Keywords

Search

Navigation