Ultrasound-guided repair of the anterior talofibular ligament with or without Gould augmentation is safe and improves clinical outcomes for chronic lateral ankle instability: A case series of 49 patients

Abstract

Objectives

We have previously shown that ultrasound-guided repair results in an accurate anchor placement and restores ankle joint stability using cadaveric models. The objective of this study is to assess the safety and clinical outcomes of ultrasound-guided anterior talofibular ligament (ATFL) repair with or without augmentation.

Methods

Forty-nine patients with chronic lateral ankle instability underwent ultrasound-guided ATFL repair with or without augmentation. Following the procedure, patients completed a standardized postoperative rehabilitation protocol. The primary outcome was the complication rate in 49 patients. The clinical outcomes were analyzed as a secondary outcome for 28 patients (20 athletes and 8 nonathletes) after excluding 21 patients with such concomitant injuries that could affect clinical course. These included (1) the Numerical Rating Scale (NRS) for pain, (2) Foot and Ankle Outcome Score (FAOS), (3) Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale (a Japanese equivalent of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot score), and (4) Self-Administered Foot Evaluation Questionnaire Sports (SAFE-Q Sports) score at baseline, 3 months, and 6 months.

Results

The overall complication rate was 2.0%, with one superficial peroneal nerve irritation out of 49 cases, which was improving at 6 months. All 4 clinical outcome scores resulted in statistically significant improvement at 6 months. NRS decreased from 3.6 ​± ​2.1 at the baseline to 1.3 ​± ​1.6 (p ​< ​0.001, Student's t-test). FAOS increased from 74.7 ​± ​11.9 to 93.4 ​± ​8.1 (p ​< ​0.001). JSSF scale increased from 56.9 ​± ​15.1 to 90.9 ​± ​10.2 (p ​< ​0.001). All 20 athletes returned to sports at a preinjury level, and their SAFE-Q sports activity scores increased from 40.7 ​± ​17.6 to 90.6 ​± ​0.2 (p ​< ​0.001).

Conclusion

Ultrasound-guided ATFL repair with or without augmentation for chronic lateral ankle instability is safe and results in clinical improvement at 6 months.

Evidence level

IV.