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Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium- and Long-Term Functional Follow-Up

Objective: To evaluate the functional outcomes of arthroscopic anatomical repair of anterior talofibular ligament
(ATFL) in the treatment of chronic lateral ankle instability (CLAI) during medium- and long-term follow-up.

Methods: From September 2014 to August 2017, the data of 37 patients (23 males, 14 females; 12 left ankles,
25 right ankles) aged between 21 and 56 years, with an average age of 32.17  6.35 years, presenting with CLAI,
was retrospectively analyzed. Among them, 32 injuries were caused by sprain and five injuries were caused by car
accidents. The course of the disease lasted for 12 to 60 months, with an average of 26.07  13.29 months. All
patients had intact skin around the ankle and no skin lesions. All patients underwent arthroscopic anatomical repair
of ATFL, with the fixation of one to two anchors. Pre- and post-operative visual analogue scales (VAS), the American
Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation.

Results: The operation was successful in all 37 cases. The operation time ranged from 40 to 75 min, with an average
of 51.25  11.49 min. After surgery, all incisions healed in stage I and there were no complications such as nerve,
blood vessel and tendon injury, implant rejection, or suture rejection. Hospital stays of postoperative patients were 3 to 5 days, with an average of 3.77  1.36 days. All patients were followed for 24 to 45 months, averaging
33.16  10.58 months. For three patients with CLAI combined with mild limitation of subjective ankle movement, joint activity was normal after rehabilitation function exercise and proprioceptive function training for 2 months. At the final follow-up, ankle pain had disappeared completely. The ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and all patients returned to normal gait. The mean VAS score decreased to 1.12  0.13, the AOFAS score increased to 92.53  4.87, and the KAFS score increased to 93.36  6.15. All the follow-up indexes were significantly different from those before surgery.

Conclusion: Arthroscopic anatomical repair of ATFL for CLAI is precise, with less surgical trauma and reliable
medium- and long-term effect.

Key words: Anterior talofibular ligament; Anatomical repair; Chronic lateral ankle instability; Minimally invasive surgery

Authors

Shi-ming Feng, MD , Qing-qing Sun, MD, Ai-guo Wang, MD, PhD,, Bu-qing Chang, MD, Jian Cheng, MD
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