Arthroscopic lateral ligament reconstruction for isolated chronic lateral ankle instability is associated with longer recovery compared to arthroscopic Broström repair and inferior extensor retinaculum augmentation

Background

Patients with chronic lateral ankle instability (CLAI) can be managed with arthroscopic Broström repair and inferior extensor retinaculum augmentation or arthroscopic assisted lateral ligament reconstruction using ipsilateral semitendinosus autograft, with good functional outcomes in patients. It is unclear whether one offers better outcome that the other. This retrospective analysis of prospectively collected data compared the outcomes of repair and reconstruction.

Methods

Patient treated for CLAI by arthroscopic Broström repair and inferior extensor retinaculum augmentation (Repair/augmentation Group; n=39) and lateral ligament reconstruction (Reconstruction Group; n=23) procedures with a minimum follow-up of 24 months were enrolled. The operative time, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Tegner score, Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the time of the patients return to sports activities were assessed.

Results

The operative time was longer in the Reconstruction Group. The patients in the Reconstruction Group experienced more pain. At 3 months after surgery, the patients in Repair/augmentation Group gained better AOFAS, KAFS, Tegner, and AJPS scores. At 6 months after surgery, better KAFS and AJPS were observed in Repair/augmentation Group. At 1 and 2 years, patients in the Reconstruction Group recorded better functional outcomes (AOFAS and KAFS) compared to the Repair/augmentation Group. The mean time of the patients return to sports activities was 10.42 ± 7.77 weeks (range, 8-56 weeks) in the Repair/augmentation Group, compared to 14.18± 5.34 weeks (range, 8-24 weeks) in the Reconstruction Group (p = 0.049).

Conclusion

In CLAI patients, arthroscopic reconstruction yields better outcomes in terms of ATT, AOFAS, and KAFS in the mid-term; however, it is associated with a longer intraoperative time, delayed return to sports, and an extended duration to resume normal ankle function compared to the arthroscopic Broström repair and inferior extensor retinaculum augmentation procedure.