Arthroscopic reconstruction of the anterior talofibular ligament and calcaneofibular ligament using allograft for chronic lateral ankle instability allows patients to successfully return to their pre-injury sports activities with Excellent clinical outcome at minimum two year follow-up.

Abstract

Purpose: To report and evaluate the time of return to work and sports of patients who underwent an anatomic arthroscopic reconstruction using allograft for chronic lateral ankle instability (CLAI) through 2 portals, and to analyze the functional results as well as the postoperative complications of the reconstruction surgery.

Methods: We retrospectively reviewed patients who underwent allograft arthroscopic reconstruction of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in the period from January 2018 to January 2022. The inclusion criteria encompassed patients with CLAI who (1) are more than 18 years old, (2) underwent arthroscopic ATFL & CF ligament reconstruction using allograft and (3) have been followed up for at least 2 years. The operation was performed with two arthroscopic portals, a percutaneous incision for CFL reconstruction and 2 knotless anchors. Time of return to work and sports was recorded. In addition, Karlsson Ankle Functional Score (KAFS), Tegner Activity Scale (TAS), visual analogue pain scale (VAS), visual analogue scale for patient satisfaction (VASPS) were evaluated preoperatively and postoperatively, and all complications were documented at a minimum follow up of two years.

Results: In total, 44 patients (mean age, 35.6±9.7 years) were included, and the average follow-up duration was 29.6±3.7 months (range, 24-42 months). The mean time of return to work was 3.29 ± 0.93 months, while the mean time of return to sports was 6.45 ± 1.55 months. KAFS increased from 53.91 ± 9.31 to 91.14 ± 6.03 (p<0.001), mean TAS increased from 2.22 ±1.05 to 7.34 ±1.51 (p<0.001), VAS decreased from 3.95 ± 1.71 to 0.43± 0.66 (p<0.001) and VASPS increased from 1.11 ±1.43 to 9.59 ± 0.76 (p<0.001). All patients (100%) achieved the minimal clinically important difference in KAFS, VAS, TAS and VASPS. Subgroup analysis indicated no statistically significant differences in functional outcomes regarding the presence/absence of Associated Intra-articular Lesions (AILs) and Body Mass Index (BMI) (greater or less than 25 kg/m²). Minor complications were observed in only 4 patients (9.1%).

Conclusion: CLAI patients who underwent arthroscopic allograft reconstruction of ATFL and CFL through two portals and an additional incision successfully returned to their pre-injury occupations within 5 months. They also returned to their pre-injury level of sports without restrictions, adaptations, or protective measures within 9 months. They demonstrated excellent clinical outcomes as all patients (100%) achieved the MCID in KAFS, VAS, TAS and VASPS at minimum of 24 months' follow-up. However, 9.1% of patients had minor neurological complications.

Level of evidence iv: A retrospective therapeutic case series.