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Arthroscopic ankle lateral ligament repair alone versus arthroscopic ankle lateral ligament repair with reinforcement by inferior extensor retinaculum

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to compare the clinical outcomes and postoperative activities of arthroscopic ankle lateral ligament (ALL) repair alone with arthroscopic ALL repair and reinforcement by the inferior extensor retinaculum (IER) for chronic ankle instability (CAI).

Materials and methods

All patients who underwent arthroscopic repair for CAI between 2017 and 2019 were evaluated. The Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q), and duration between the surgery and walking without any support, jogging, and complete return to sports were evaluated and compared. The exclusion criteria were (1) follow-up period of < 1 year after surgery, (2) the presence of associated ankle lesions requiring treatment during the same operative procedure, including patients with subfibular ossicle bigger than 5 mm on radiographs, chondral or osteochondral defect, bony impingement, deltoid ligament tear, fibular tendon pathology, or posterior ankle impingement, and (3) patients who underwent revision surgery.

Results

We identified 126 patients who underwent surgery for CAI and subsequently excluded 36 patients on account of a short follow-up period (< 1 year), additional surgery, and previous surgery. The remaining 90 eligible patients included arthroscopic ALL repair alone (group A, n = 44) and arthroscopic ALL repair with reinforcement by the inferior extensor retinaculum (group G, n = 46) groups. There was no significant difference in the postoperative activities nor in the preoperative or postoperative JSSF scale and SAFE-Q between the two groups. However, significant differences were seen in the mean surgical time (15.5 ± 8.1 vs 20.1 ± 7.6, P = 0.013).

Conclusion

This study showed no difference in clinical outcomes between the two groups. However, arthroscopic ALL repair with reinforcement by IER resulted in a longer surgical time than arthroscopic ALL repair alone.

Level of evidence

Retrospective comparative study, level III.

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Abbreviations

CAI:

Chronic ankle instability (CAI)

IER:

Inferior extensor retinaculum (IER)

ALL:

Ankle lateral ligament (ALL)

JSSF:

The Japanese Society for Surgery of the Foot scale (JSSF)

SAFE-Q:

Self-administered foot evaluation questionnaire (SAFE-Q)

MM:

Medial midline portal (MM)

acAL:

Accessory anterolateral (acAL)

AITFL:

Anterior inferior tibiofibular ligament (AITFL

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Funding

No funds were received in support of this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery (Ohashi), School of Medicine, Toho University, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan

    Yuji Samejima, Hiroyasu Ikegami & Yoshiro Musha

  2. Department of Orthopaedic Surgery, Toho University Graduate School of Medicine, 5-21-16 Omorinishi, Ota-ku, Tokyo, 143-8540, Japan

    Yuji Samejima

  3. Clinical and Research Institute for Foot and Ankle Surgery Jujo Hospital, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan

    Ryota Inokuchi, Kosui Iwashita, Yasuyuki Jujo & Masato Takao

  4. Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan

    Ryota Inokuchi

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Contributions

YS collected and analysed the data and drafted the manuscript. MT conceived of the study, participated in its design, collected and analysed the data and coordination and helped to draft the manuscript. MT is also the corresponding author. RI collected, analysed the data, and critically reviewed the manuscript. KI, HI, YM and YJ collected and analysed the data. MT gave final approval to the manuscript.

Corresponding author

Correspondence to Masato Takao.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of the Japan Medical Association (R1-6).

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Informed consent was obtained from all patients prior to study participation.

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Samejima, Y., Inokuchi, R., Iwashita, K. et al. Arthroscopic ankle lateral ligament repair alone versus arthroscopic ankle lateral ligament repair with reinforcement by inferior extensor retinaculum. Arch Orthop Trauma Surg 141, 987–995 (2021). https://doi.org/10.1007/s00402-021-03771-w

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  • DOI: https://doi.org/10.1007/s00402-021-03771-w

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