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All-inside arthroscopic repair of the anterior talofibular ligament: a case series

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 Abstract

Introduction

The all-inside arthroscopic repair of the anterior talofibular ligament (ATFL) is a technically challenging and still-recent procedure to treat chronic ankle instability (CAI). Favourable clinical outcomes have been shown from originator centers, but this is one of the first series from a non-originator centre. The purpose of the present study is to present the clinical and functional results of patients with CAI underwent arthroscopic all-inside ATFL repair.

Methods

This is a series of cases of 18 consecutive patients who underwent the all-inside arthroscopic ATFL repair, for CAI, after the failure of conservative treatment performed for six months. The evaluation was made using the American Orthopaedic Foot and Ankle Score (AOFAS), visual analog pain scale (VAS), anterior drawer, and talar tilt tests.

Results

All 18 patients were evaluated for a mean follow-up period of 12 months. There was an improvement in the AOFAS (p < 0.001), with the mean improving from 69.6 points to 98.1, standard deviation (SD) = 11.09, and in the mean VAS score (p < 0.001), from 5.0 to 0.5 points (SD = 0.78). All ankles were stable, as assessed by the anterior drawer test and talar tilt test. The only complication found was neurapraxia of the superficial fibular nerve in one patient (5%). All of the patients classified the treatment as good or excellent and returned to sports activities without limitations.

Conclusion

Treatment of CAI by the all-inside arthroscopic ATFL repair was able to restore ankle stability and showed good clinical results and high satisfaction rates.

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Availability of data and materials

The datasets generated during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Foot and Ankle Unit, Hospital Brasília, Brasília, Distrito Federal, Brazil

    Gustavo Araujo Nunes

  2. Grecmip MIFAS (Group of Research and Study in Minimally Invasive Surgery of the Foot – Minimally Invasive Foot and Ankle Society), Barcelona, Spain

    Gustavo Araujo Nunes

  3. PHD (C) Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain

    Gustavo Araujo Nunes

  4. Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil

    Gabriel Ferraz Ferreira

  5. Orthopaedics and Traumatology Unit, Hospital Universitário Ciências Médicas (FCMMG), Belo Horizonte, MG, Brazil

    Rafael Medeiros Caetano

  6. Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil

    Tania Szejnfeld Mann

  7. Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy

    Matteo Guelfi

Authors
  1. Gustavo Araujo Nunes
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  2. Gabriel Ferraz Ferreira
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  3. Rafael Medeiros Caetano
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  4. Tania Szejnfeld Mann
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  5. Matteo Guelfi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Gustavo Araujo Nunes, Gabriel Ferraz Ferreira, Rafael Medeiros Caetano, Tania Szejnfeld Mann, and Matteo Guelfi. The first draft of the manuscript was written by Gustavo Araujo Nunes, Gabriel Ferraz Ferreira, and Rafael Medeiros Caetano, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gustavo Araujo Nunes.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of Medical Institution on the Plataforma Brasil, CAAE number: 45339221.0.0000.5128. ICMJE forms for all authors are available online.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1, 2, and 3. The participant has consented to the submission of this case series to the journal.

Conflict of interest

The authors declare no competing interests.

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Highlights

- The first case series from nonoriginator center of this procedure

- Homogeneous case series operated and followed by the same surgeon

- Important clinical and functional improvement with a low rate of complications

- High rate of return to sports after the procedure

- Restoration of ankle stability in all cases, including those with associated CFL injury

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Cite this article

Nunes, G.A., Ferreira, G.F., Caetano, R.M. et al. All-inside arthroscopic repair of the anterior talofibular ligament: a case series. International Orthopaedics (SICOT) 46, 273–279 (2022). https://doi.org/10.1007/s00264-021-05283-z

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  • DOI: https://doi.org/10.1007/s00264-021-05283-z

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