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The arthroscopic all-inside ankle lateral collateral ligament repair is a safe and reproducible technique

Knee Surgery, Sports Traumatology, Arthroscopy volume 28, pages 63–69 (2020)Cite this article

Abstract

Purpose

Neurovascular structures around the ankle are at risk of injury during arthroscopic all-inside lateral collateral ligament repair for the treatment of chronic ankle instability. This study aimed to evaluate the risk of damage to anatomical structures and reproducibility of the technique amongst surgeons with different levels of expertise in the arthroscopic all-inside ligament repair.

Methods

Twelve fresh-frozen ankle specimens were used for the study. Two foot and ankle surgeons with different level of experience in the technique performed the procedure on 6 specimens each. The repair was performed following a standardized procedure as originally described. Then, an experienced anatomist dissected all the specimens to evaluate the outcome of the ligament repair, any injuries to anatomical structures and the distance between arthroscopic portals and the superficial peroneal nerve (SPN) and sural nerve.

Results

Dissections revealed no injury to the nerves assessed. Mean distance from the anterolateral portal and the SPN was of 4.8 (range 0.0–10.4) mm. The mean distance from the accessory anterolateral portal to the SPN and sural nerve was of 14.2 (range 7.1–32.9) mm and 28.1 (range 2.8–39.6) mm, respectively. The difference between the 2 surgeons’ groups was non-statistically significant for any measurement (mm). In all specimens both fascicles of the anterior talofibular ligament were reattached onto its original fibular footprint. The calcaneofibular ligament was not penetrated in any specimen.

Conclusions

The all-inside arthroscopic lateral collateral ligament repair is a safe and reproducible technique. The clinical relevance of this study is that this technique provides a safe and anatomic reattachment of the anterior talofibular ligament, with minimal risk of injury to surrounding anatomical structures regardless of the level of experience with the technique.

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Acknowledgements

This study was realized at ArthroLab™ in Munich (Germany). The authors would like to thank Arthrex GmbH for providing cadaveric specimens and all the surgical instruments needed for the study.

Funding

Arthrex GmbH provided the laboratory, surgical instruments and cadaveric specimens for the study. No other external funding was used.

Author information

Affiliations

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

    Matteo Guelfi

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

    Matteo Guelfi

  3. Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitad Autònoma de Barcelona, Barcelona, Spain

    Matteo Guelfi

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

    Jordi Vega, Francesc Malagelada & Miki Dalmau-Pastor

  5. GRECMIP (Groupe de Recherche et d’Etude en Chirurgie Mini-Invasive du Pied), Merignac, France

    Jordi Vega & Miki Dalmau-Pastor

  6. Foot and Ankle Unit, Hospital Quirón Barcelona, and iMove Traumatology Tres Torres, Barcelona, Spain

    Jordi Vega

  7. Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK

    Francesc Malagelada

  8. Manresa Health Science School, University of VIC-Central University of Catalonia, Barcelona, VIC, Spain

    Miki Dalmau-Pastor

Authors
  1. Matteo Guelfi
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  2. Jordi Vega
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  3. Francesc Malagelada
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  4. Miki Dalmau-Pastor
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Corresponding author

Correspondence to Matteo Guelfi.

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All authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the University of Barcelona with IRB number: 00003099.

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Guelfi, M., Vega, J., Malagelada, F. et al. The arthroscopic all-inside ankle lateral collateral ligament repair is a safe and reproducible technique. Knee Surg Sports Traumatol Arthrosc 28, 63–69 (2020). https://doi.org/10.1007/s00167-019-05427-0

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Keywords

  • Anatomy
  • Ankle arthroscopy
  • Chronic ankle instability
  • Learning curve
  • Ligament repair