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Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability

Knee Surgery, Sports Traumatology, Arthroscopy volume 28, pages 132–140 (2020)Cite this article

Abstract

Purpose

When the anterior fascicle of the deltoid ligament is injured in patients with chronic ankle instability, the diagnosis of rotational ankle instability is supported. The aim of this study was to report the results of an all-arthroscopic technique to concomitantly repair the lateral collateral and deltoid ligaments to treat patients with rotational ankle instability.

Methods

Thirteen patients [12 men and 1 woman, median age 32 (15–54) years] with rotational ankle instability were treated by arthroscopic means after failing non-operative management. Median follow-up was 35 (18–42) months. Using a suture passer and knotless anchors, the ligaments were repaired with an arthroscopic all-inside technique.

Results

During diagnostic arthroscopy, 12 patients showed an isolated anterior talofibular ligament (ATFL) injury, and in one patient, both the ATFL and calcaneofibular ligament were affected. Arthroscopic examination of the deltoid ligament demonstrated a tear affecting the anterior area of the ligament in all cases. The tear was described as an "open book" tear, because the ligament was separated from the medial malleolus when applying passive internal rotation of the tibio-talar joint. This gap was closed when the tibio-talar joint was in neutral rotation or externally rotated. All patients reported subjective improvement in their ankle instability after the arthroscopic all-inside ligaments repair. The median AOFAS score increased from 70 (44–77) preoperatively to 100 (77–100) at final follow-up.

Conclusion

Rotational ankle instability can be successfully treated by an arthroscopic all-inside repair of the lateral and medial ligaments of the ankle.

Level of evidence

Level IV, retrospective case series.

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Acknowledgements

The authors would like to thank Iris Kwok for her contribution in editing the manuscript.

Author information

Affiliations

  1. Foot and Ankle Unit, Hospital Quirón Barcelona, Plaza Alfonso Comín 5, 08023, Barcelona, Spain

    Jordi Vega

  2. 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

  3. Foot and Ankle unit, Etzelclinic, Pfäffikon, Switzerland

    Jörg Allmendinger

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

    Francesc Malagelada

  5. Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. d’Annunzio, Chieti-Pescara, Chieti, Italy

    Matteo Guelfi

  6. Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain

    Miki Dalmau-Pastor

Authors
  1. Jordi Vega
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  2. Jörg Allmendinger
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  3. Francesc Malagelada
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  4. Matteo Guelfi
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  5. 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.

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The authors received no financial support for the research, authorship, and/or publication of this article.

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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Cite this article

Vega, J., Allmendinger, J., Malagelada, F. et al. 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 (2020). https://doi.org/10.1007/s00167-017-4736-y

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  • DOI: https://doi.org/10.1007/s00167-017-4736-y

Keywords

  • Ankle arthroscopy
  • Ankle instability
  • Rotational instability
  • Deltoid ligament
  • Treatment