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A four-step approach improves long-term functional outcomes in patients suffering from chronic ankle instability: a retrospective study with a follow-up of 7–16 years

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

Abstract

Purpose

The aim of the present study was to assess the long-term outcomes of the treatment of chronic ankle instability (CAI) with a four-step protocol.

Methods

Fifty-four patients with isolated anterior talo-fibular ligament (ATFL) lesion suffering from CAI who underwent surgical treatment between 2000 and 2009 were assessed. All the patients underwent a four-step protocol including synovectomy, debridement of ATFL lesion borders, capsular shrinkage, and 21-day immobilization and nonweightbearing. Median age at surgery was 31.6 years (18–48). Patients were examined preoperatively and at follow-up. Clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system, Karlsson–Peterson score, Tegner activity level, and objective examination comprehending range of motion (ROM) and manual laxity tests.

Results

AOFAS (preoperative, 64.8; postoperative, 92.4; p < 0.001) and Karlsson-Peterson score (preoperative, 62.5; postoperative, 88.8; p < 0.001) significantly improved after a median 11 years follow-up (7–16 years). Similarly median Tegner activity level significantly increased at follow-up compared to pre-operatory status (6.0 and 4.0 respectively, p < 0.001). Objective examination documented a statistically significant improvement in terms of ankle stability compared to pre-operative manual laxity tests, with negative anterior drawer test observed in 48 (88.9%) patients (p < 0.001). Sagittal ROM was full in 50 patients (92%). Nine patients had subsequent ankle sprains (15.6%), two patients required further surgery, while seven were treated conservatively. No major complications were reported.

Conclusion

Satisfying subjective and objective clinical outcomes in selected patients with isolated ATFL lesion suffering from CAI were reported with a treatment protocol including arthroscopic synovectomy, debridement of ATFL remnants, capsular shrinkage, and immobilization. These findings are of clinical relevance because they provide a suitable minimally invasive method for the treatment of mild to moderate ankle instability.

Level of evidence

Level IV

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Acknowledgements

The authors wish to thank Michela Groppo, MD for the assistance with manuscript editing.

Funding

This research was supported by the Italian Ministry of Health.

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Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy

    Alberto Ventura, Enrico Borgo, Vittorio Macchi & Claudio Legnani

  2. Department of Orthopaedics, Istituto Clinico Villa Aprica, Como, Italy

    Clara Terzaghi

Authors
  1. Alberto Ventura
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  2. Enrico Borgo
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  3. Clara Terzaghi
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  4. Vittorio Macchi
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  5. Claudio Legnani
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Correspondence to Claudio Legnani.

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This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Ventura, A., Borgo, E., Terzaghi, C. et al. A four-step approach improves long-term functional outcomes in patients suffering from chronic ankle instability: a retrospective study with a follow-up of 7–16 years. Knee Surg Sports Traumatol Arthrosc 29, 1612–1616 (2021). https://doi.org/10.1007/s00167-020-06368-9

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  • DOI: https://doi.org/10.1007/s00167-020-06368-9

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