ObjectiveTo compare the effectiveness between modified Brostrom method repair and anatomical reconstruction anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) with single fibular tunnel for chronic lateral ankle instability. MethodsTwenty ankle specimens of fresh cadaver were dissected to provide the anatomic data of ATFL and CFL and to observe the neurovascular distribution. Between January 2008 and December 2011, 48 patients (48 ankles) with chronic lateral ankle instability were randomly divided to groups A and B (n=24). The direct repair of ATFL and CFL by modified Brostrom method was performed in group A, and anatomic doublebundle reconstruction of ATFL and CFL with free semitendinosus tendon autograft in group B. There was no significant difference in sex, age, body mass index, injury side, the causes of injury, interval of injury and operation, talar tilt angle, talus forward shift, ankle plantar flexion, dorsiflexion, valgus, varus, American Orthopaedic Foot and Ankle Society (AOFAS) score, and visual analogue score (VAS) between 2 groups (P>0.05). The image parameters and range of motion were compared between 2 groups after operation; AOFAS and VAS scores were used to evaluate the effectiveness. ResultsAll the incisions healed by first intention in 2 groups; no complication of nerve injury, infection, or skin necrosis was observed. All the patients were followed up 2-5 years (mean, 3.4 years); no subtalar stiffness or recurrent instability occurred during follow-up. The talar tilt angle, talus forward shift, AOFAS score, and VAS score were significantly improved at 2 years after operation when compared with preoperative ones in 2 groups (P<0.05). There was no significant difference in range of motion of ankle plantar flexion, dorsiflexion, and ankle valgus, and VAS score between 2 groups (P>0.05), but group B was significantly better than group A in the range of motion of ankle varus, talar tilt angle, talus forward shift, and AOFAS score (P<0.05). In the each item of AOFAS score, there was no significant difference in pain, abnormal gait, support and autonomic function, ankle flexion and extension, hind foot motion, and alignment between 2 groups (P>0.05), but group B was significantly better than group A in walking, maximum walking distance, and ankle stability (P<0.05). ConclusionThe described technique, which involves anatomic double-bundle reconstruction of the ATFL and CFL with single fibular tunnel and modified incision, is a viable option for treating lateral ankle instability, especially for young patients who need high stability and revision.
Objective To investigate the short-term effectiveness of arthroscopic Lasso-Loop suture combined with Suture Tape augmentation in treatment of lateral ankle instability. Methods A total of 19 patients with lateral ankle instability were enrolled between January 2022 and August 2022, including 11 males and 8 females, with a mean age of 35.5 years (range, 16-68 years). All patients underwent arthroscopic repair of the anterior talofibular ligament (ATFL) using Lasso-Loop suture combined with Suture Tape augmentation. Injury causes consisted of sports injury in 14 cases, sprain in 4 cases, and traffic accident injury in 1 case. There were 6 cases of acute injury and 13 cases of chronic injury. Anterior drawer test was positive in all 19 patients, and varus stress test was positive in 6 patients. Imaging examinations revealed the talar osteochondral lesions in 3 cases, including 2 cases of Outerbridge grade Ⅲ and 1 case of grade Ⅳ. Preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score was 71 (62, 72), and the Kaikkonen ankle injury functional score was 40 (25, 50). Results The incisions in 18 cases healed by first intension; the incision fat liquefaction occurred in 1 patient and recovered after dressing changes. All patients were followed up 12 months. At 12 months after operation, both anterior drawer test and varus stress test were negative. At 6 weeks and 12 months after operation, the AOFAS ankle-hindfoot scores of the affected ankle were 85 (80, 90) and 100 (100, 100), respectively, while the Kaikkonen ankle injury functional scores were 89 (89, 98) and 100 (100, 100), respevtively. All scores significantly improved when compared with preoperative levels and showed a gradual upward trend over time, with significant differences (P<0.05). At 12 months after operation, the AOFAS ankle-hindfoot scores in 19 patients achieved excellent, with an excellent and good rate of 100%. Conclusion For patients with lateral ankle instability, arthroscopic debridement combined with ATFL reconstruction using the Lasso-Loop suture and Suture Tape augmentation can achieve satisfactory short-term effectiveness.