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Surgical diagrams of arthroscopic anatomical repair of anterior talofibular ligament (ATFL). (A) The intact ATFL was avulsed from the fibula. (B) The bone of the fibula footprint was freshened using a Pituitary Rongeur or 1.0 mm Kirschner wire drill. (C) A double wire anchor with a diameter of 3.5 mm was inserted in the middle area of the fibula footprint. (D) The suture method of the first anchor sutural wire. (E) The suture method of the second anchor sutural wire. (F) The ATFL was sutured.
Source publication
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)...
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Methods:
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Citations
... 3 Although there is no agreement in the current literature on whether arthroscopic surgery or open surgery is more helpful for CLAI, nowadays more and more scholars recommend the use of arthroscopic anatomical repair. 14 The current literature reports mainly focus on the shortterm effect of objective direct repair to ATFL for CLAI. Literature reports on the 2-4 year functional outcomes, including with a relatively large number of patients, are sparse. ...
... Finally, return to function and hospital stays are shorter. 14,33 The functional outcomes of this procedure support its efficacy and safety for treatment of CLAI. The mean VAS score dropped to 0.39, whereas the AOFAS and KAFS scores rose to 95.17 and 95.00, respectively. ...
... In accordance with our findings, Feng et al 14 Through a systematic analysis, Guelfi et al 20 compared the outcomes of arthroscopic versus open surgery in 505 cases to report that both open surgery and arthroscopic surgery could effectively treat CLAI. Additionally, postoperative patient satisfaction with arthroscopic surgery was significantly higher. ...
Background
To assess the clinical and functional outcomes of all-inside arthroscopic anatomical repair of anterior talofibular ligament (ATFL) for management of chronic lateral ankle instability (CLAI) in a considerable number of patients during medium-term follow-up.
Methods
A retrospective analytic study was performed on 100 patients with CLAI who presented between August 2015 and July 2020 (average age: 32.9 years; range: 16-54 years). All-inside arthroscopic ATFL direct repair was performed in all patients through 2 portals only with fixation using 2 knotless anchors. Associated intraarticular lesions were treated in the same procedure. Outcomes were assessed with pre- and postoperative visual analog scale (VAS), the ankle-hindfoot score of the American Orthopaedic Foot & Ankle Society (AOFAS), and the Karlsson Ankle Functional Score (KAFS).
Results
All patients were followed for 24-48 months. At the final follow-up, ankle pain had improved significantly. Both the ankle anterior drawer test and the ankle varus stress tests were negative. There was no loss of ankle range of motion compared with preoperative measures, and all patients returned to normal gait. The mean VAS score decreased to 0.39 ± 0.63, the AOFAS score increased to 95.17 ± 4.7, and the KAFS score increased to 95 ± 4.07. All the follow-up indexes significantly improved compared to those before surgery.
Conclusion
At minimum 24-month follow-up, the all-inside arthroscopic ATFL repair used to treat CLAI was found to restore ankle stability and yield good clinical outcomes with a relatively low complication rate.
Level of Evidence
Level III, retrospective cohort study.
... Arthroscopic Broström-Gould repair has been found to provide good-to-excellent clinical results (94.7%) at a mean follow-up of 9.8 years. 21 Feng et al. 22 reported favourable clinical results at a 2-year follow-up after arthroscopic ATFL repair. Thus, the current study demonstrated a new technique with clinical results comparable with those of previous reports. ...
Background/objective
Arthroscopic lateral ligament repair (ALLR) for chronic lateral ankle instability (CLAI) has been improving with technical innovations. However, there is a lack of information regarding mid- and/or long-term clinical outcomes after the introduction of ALLR. This study aimed to report mid-term clinical outcomes of ALLR with a knotless anchor.
Methods
Thirty-two patients (11 men and 21 women; mean age, 28 ± 14 years) who underwent ALLR with a knotless anchor from December 2015 to October 2020 were included. The mean follow-up period was 31 ± 11 months. The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were used for clinical evaluation preoperatively and at the 2-year follow-up. Surgical complications, particularly knot irritation, were also examined.
Results
The JSSF scale scores were significantly improved, from 71.3 ± 13.1 preoperatively to 96.6 ± 5.1 postoperatively (P < 0.05), and the SAFE-Q showed similar improvement in all subscales (P < 0.05). One case had a complication of persistent pain around the lateral portal (3.1%).
Conclusion
ALLR using a knotless anchor provided satisfactory clinical outcomes over 2 years, and no major complications, such as knot irritation, were observed.
Case series
Level of Evidence, 4.
... This systematic review discussed the complication rates of various studies on the arthroscopic Brostrom technique and the modified Brostrom-Gould technique. The most important finding in the arthroscopic Brostrom technique was that complication rates ranged from 0% in some studies to 29% in other studies [15,51,52]. For the modified Brostrom-Gould technique, on the other hand, the complication rates ranged from 0% complication rates in some studies to 30% complication rates in others [38,48]. ...
Injury to the lateral ligament is the most common cause of chronic lateral ankle instability. Lateral ankle instability is usually managed through conservative management, but surgery is indicated if this fails to relieve the symptoms. Surgical repair of the lateral ligament involves many surgical techniques including the arthroscopic repair technique and the modified Brostrom-Gould technique. Due to the minimal research on the complication rates of both techniques, this systematic review aims to establish the complication rates. To obtain articles, a detailed systematic search of MEDLINE, PubMed, Embase, Web of Science, and Cochrane Library was performed. The articles found using the keywords “arthroscopic,” “Brostrom,” and “Brostrom-Gould” were reviewed by two independent authors. The authors then selected the articles according to our predetermined eligibility criteria. The articles that met our inclusion were then chosen for data extraction. Specific details obtained from the study included the author’s details, the setting of the study, and the complications of the study. The online search yielded 975 articles, but only 44 met our inclusion criteria and were included in the review. The total sample size for the review was 2041 patients, the modified Brostrom technique was performed on 760 patients while on the remaining 1281 patients, arthroscopic repair was performed. On the characteristics of the sample, the age of the samples ranged from eight years to 83 years, while the mean BMI ranged from 21.0 kg/m² to 25.3 kg/m². The various complication rates included superficial peroneal nerve injury (2.3% in arthroscopic Brostrom and 0.65% in the Brostrom-Gould), wound infections (1.3% in arthroscopic Brostrom and 1.8% in the Brostrom-Gould), persistent pain (1.5% in the arthroscopic Brostrom and 1.1% in the Brostrom-Gould), and lastly recurrent instability (0.31% in arthroscopic Brostrom and 3.0% in the Brostrom-Gould). Overall, the complication rates of the arthroscopic repair were 11.00%, while those of the modified Brostrom-Gould were 10.65%. The study demonstrated that although the arthroscopic technique had higher complication rates than the modified Brostrom technique, the difference was insignificant. Therefore, we concluded that surgeons performing the arthroscopic Brostrom technique should have good arthroscopic skills to minimize complications.
... LARS was also used for ATFL reconstruction in CLAI patients, which got excellent clinic efficacy and achieved good ankle stability compared to the modified Broström repair [24,25]. However, some studies demonstrated that limitations of ATFL reconstruction in ankle activity following and the removal of ATFL remnants can potentially affect ankle functional recovery similar to remnant-preserved anterior cruciate ligament (ACL) reconstruction [26,27], and ATFL remnant preservation was benefit for proprioceptive recovery [28]. In addition, early range of motion rehabilitation has also been demonstrated to improve ankle strength, mechanical stability, and return to activity outcomes compared to cast immobilization [29,30]. ...
... In-situ ligament repair can maintain the histological and immunohistochemical signatures of the neural receptors responsible for proprioception. Moreover, rehabilitation programs based on proprioception are becoming more popular in patients with joint injuries [28]. While early training in range of motion after ligament repair is beneficial for effective rehabilitation, especially in proprioception recovery, several studies have emphasized the importance of protection from excessive stress during the early post-operative rehabilitation phase after Broström repair [14,28]. ...
... Moreover, rehabilitation programs based on proprioception are becoming more popular in patients with joint injuries [28]. While early training in range of motion after ligament repair is beneficial for effective rehabilitation, especially in proprioception recovery, several studies have emphasized the importance of protection from excessive stress during the early post-operative rehabilitation phase after Broström repair [14,28]. Lengthening of 20% in the ATFL after Broström repair with unprotected mobilization [38]. ...
Background
Ankle sprain are one of the most frequent sports injuries. Some individuals will develop chronic lateral ankle instability (CLAI) after ankle sprain and suffer from recurrent ankle sprain. Current surgical treatment of CAI with anterior talofibular ligament (ATFL) rupture fails to restore the stability of the native ATFL. Ligament Advance Reinforcement System (LARS) augmentation repair of ATFL was developed to improve its primary stability after repaired.
Methods
This study was performed to evaluate whether LARS augmentation repair of ATFL had similar stability as the modified Broström repair and the intact ATFL to maintain ankle construct stability. Standardized surgical techniques were performed on eighteen fresh frozen cadaver ankle specimens. The intact ATFL group has just undergone an ATFL exploratory surgery. The modified Broström procedure is based on anatomical repair of the ATFL with a 2.9 mm suture anchor, and the LARS procedure is an augmentation procedure of the ATFL using LARS ligaments based on the modified Broström procedure. A dynamic tensile test machine was used to assess load-to-failure testing in the three groups. The ultimate failure load and stiffness were calculated and reported from the load-displacement curve. A one-way analysis of variance was used to detect significant differences (p < 0.05) between the LARS augmentation repair, the modified Broström repair and the intact ATFL, followed by least significant difference (LSD) post-hoc tests.
Results
The LARS augmentation repair group showed an increased in ultimate failure to load and stiffness compared to the other two groups. There were no significant differences in ultimate failure to load and stiffness between the modified Broström and the intact ATFL, the LARS ligament for ATFL augmentation allows for improved primary stability after repair and reduced stress on the repaired ATFL, which facilitates healing of the remnant ligament.
Conclusions
The LARS augmentation repair of ATFL represents a stable technique that may allow for the ankle stability to be restored in patients with CAI after surgery.
... 56 Arthroscopic techniques involve "Arthro-Broströ m" type anatomic repairs and autologous or allogeneic graft reconstructions. 47,[57][58][59][60][61][62][63][64][65][66] These reconstructions require high arthroscopic skill to minimize the risk of iatrogenic injury to the cartilage. All carry a risk of complications, mainly neurovascular injury, due to the creation of portals and the passage of sutures, even under direct arthroscopic visualization. ...
... Incisional complications, tendon injuries, deep venous thrombosis, and recurrence of instability have also been described. [57][58][59][60][61][62][63][64][65][66] The higher cost of the procedure due to the use of more sophisticated instruments and materials must also be considered. Compared with the open technique, arthroscopic lateral ligament repair is technically more demanding. ...
Lateral ligament attenuation may occur after repetitive ankle sprains, creating instability. Management of chronic ankle instability requires a comprehensive approach to mechanical and functional instability. Surgical treatment, however, is indicated when conservative treatment is not effective. Ankle ligament reconstruction is the most common surgical procedure to resolve mechanical instability. Anatomic open Broström-Gould reconstruction is the gold standard for repairing affected lateral ligaments and returning athletes to sports. Arthroscopy may also be beneficial for identifying associated injuries. In severe and long-standing instability, reconstruction with tendon augmentation could be necessary.
... Surgical management is recommended after failure of 6 months of conservative management in CLAI patients [10,[21][22][23][24]. Broström first reported ATFL repair for CLAI treatment, and in the next decades, ATFL repair is proved as the optimal reliable option [25,26]. The ATFL remnant is of good quality in most CLAI patients, and direct anatomical repair is generally possible [27], with comparable stability and functional outcomes following arthroscopic ATFL and open repair [28,29]. ...
Background
Anatomic repair of anterior talofibular ligament (ATFL) is used to manage chronic lateral ankle instability (CLAI). However, the optimal suture configuration used to repair the ATFL is not yet determined. It remains unclear whether suture configuration affects clinical outcomes in such patients.
Purpose
To compare the functional outcomes of all-inside arthroscopic ATFL repair using either a loop suture and or a free-edge suture configuration in CLAI patients.
Study Design
Cohort study; Level of evidence, 3.
Methods
This retrospective cohort study included 71 patients with CLAI who had undergone an all-inside arthroscopic ATFL repair procedure with either loop suture ( n = 36) or free-edge suture ( n = 35) from February 2016 to July 2018. Comparable pre-operatively, the Visual analogy score (VAS), American Orthopedic Foot and Ankle Society scoring system (AOFAS), Karlsson Ankle Functional Score (KAFS) scoring system, Anterior Talar Translation (ATT) and Active Joint Position Sense (AJPS) were used to evaluate postoperative ankle function.
Results
There were no postoperative wound complications, implant reactions, or neurological or vascular injuries. Postoperative hospitalization, VAS, AOFAS, KAFS, AJPS and the time of return to sport were similar between the loop suture group and free-edge suture group. Requiring a longer procedure time, patients with loop suture configuration achieved better ATT.
Conclusion
All-inside arthroscopic ATFL repair procedure for CLAI treatment provides better ATT and comparable functional outcomes when a loop suture configuration is used instead of a free-edge suture configuration. A statistical difference in ATT was observed. Given the relatively short follow-up, it is questionable whether this will have any clinical relevance.
... [10][11][12] Currently, due to the prevalence of minimally invasive concepts, the main methods of ligament reconstruction are percutaneous reconstruction and arthroscopic reconstruction. [13][14][15] Percutaneous reconstruction often requires repeated x-ray fluoroscopic confirmation, which will undoubtedly increase the operative time and aggravate the damage to the medical staff and patients. [16,17] However, due to the rapid development of arthroscopic techniques, more and more experts and scholars have mastered the all-scopic reconstruction of ATFL and CFL ligaments. ...
Background:
Ankle sprains occur very frequently in daily life, but people who do not pay attention to them and do not receive proper diagnosis and treatment are very prone to develop chronic ankle lateral instability (CALI) at a later stage. For CALI where conservative treatment has failed, reconstruction of the lateral collateral ligament of the ankle can achieve satisfactory results, but there are various and controversial ways of ligament reconstruction. While percutaneous reconstruction of ankle lateral ligament (PLCLR) needs to be performed repeatedly under fluoroscopy, total arthroscopic reconstruction of ankle lateral ligament (ALCLR) is increasingly recognized by experts and scholars for its minimally invasive and precise characteristics, and has achieved good clinical results. Therefore, it is imperative that a meta-analysis be performed to provide evidence as to whether there is a difference between ALCLR and PLCLR in the treatment of CALI.
Methods:
We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure, Wanfang Data, Chinese Scientific Journals Database, Chinese databases SinoMed, PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to September 2022.We will apply the risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software.
Results:
This systematic review will evaluate the functional outcomes and radiographic results of ALCLR in the treatment of CALI.
Conclusion:
The conclusion of this study will provide evidence for judging whether ALCLR is superior to PLCLR for treatment of CALI.
Trial registration number:
CRD42022362045.
... However, it also has disadvantages, such as large incisions, hard debridement of soft tissue impingement or synovitis, excision of osteophytes, microfracture, or abrasion arthroplasty for osteochondral lesions of the talus. In addition, patients need to use plaster or braces for weeks after surgery [16], which may result in stiffness of the ankle and prolonged recovery time in some patients after surgery [17]. With the development of arthroscopic technology and the emergence of new equipment and instruments, arthroscopic procedures of ATFL repair have achieved as good clinical efficacy as open procedures. ...
Objective
To introduce the surgical technique and clinical outcomes of arthroscopic anterior talofibular ligament (ATFL) repair using the Internal Brace and lasso-loop technique for chronic ankle lateral instability.MethodsA retrospective study was performed on 29 patients who underwent all-arthroscopic ATFL repair with the Internal Brace and lasso-loop technique from January to August 2020. The patients included 24 males and five females, with a mean age of 30.17 years. Through the accessory anterolateral (AAL) portal, we drilled the bone tunnels and fixed the tape with 4.75 mm and 3.5 mm “SwiveLock” anchors and reattached the torn ligament by the lasso-loop technique.ResultsAll 29 patients underwent all-arthroscopic procedures smoothly without serious complications, such as infection and important nerve or vessel injuries. There were eight cases of lateral malleolar avulsion fractures and ten cases of talus cartilage injury. The visual analog scale (VAS), Karlsson-Peterson, Tegner, and American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the clinical consequences. All the patients were followed up for 18.66 ± 4.85 months on average. The average pre-operative VAS score was 4.69 ± 1.04, which was significantly higher than the average post-operative VAS score of 1.14 ± 1.56. At the final follow-up appointments, the averages of Karlsson-Peterson, AOFAS, and Tenger scores were 75.83 ± 9.44, 88.31 ± 6.81, and 6.93 ± 1.79, respectively, which was significantly higher than that before the operation.Conclusion
This arthroscopic anterior talofibular ligament repair with the Internal Brace and lasso-loop technique achieves satisfactory clinical outcomes with the benefits of high safety and reliability for chronic ankle lateral instability.
... The main features of PROMs are the consistent findings and good performance in clinical studies; AOFAS recommends the use of PROMs to assess clinical and functional conditions and treatment outcomes (14) . The AOFAS scale uses a combination of medical evaluation and patient response and is therefore not considered a PROM-based scale (11) ; in contrast, there is evidence that the Karlsson-Peterson scale can be considered a PROM-based scale (15)(16)(17)(18)(19) . Likewise, the Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS) scales recommended for foot and ankle are also considered PROM-based scales (11,20) and have been used to evaluate MBG plasty and suture tape augmentation outcomes (1,2,21,22) . ...
Objective: The objective of this study was to evaluate the performance of the American Orthopedic Foot and Ankle Society (AOFAS) and Karlsson-Peterson scales in patients with lateral ankle instability treated with modified Bröstrom-Gould (MBG) plasty and suture tape augmentation. Methods: This retrospective, bicentric, cohort study involved consecutive patients with lateral ankle instability treated with MBG plasty and suture tape augmentation. The Visual Analog Scale (VAS), AOFAS scale, and Karlsson-Peterson scale were used in pre-/postoperative assessments. Results: Fifty-five patients who underwent MBG plasty and suture tape augmentation were included. Mean preoperative and postoperative VAS scores were 7.1 ± 1.4 and 1.3 ± 1.6 (p<0.001), respectively. Mean AOFAS scores were 61.3 ± 21.1 and 95.4 ± 8.4, respectively (p<0.001). Mean Karlsson-Peterson scale scores were 46.8 ± v14.3 and 95.2 ± v7.9 (p<0.001), respectively. Conclusions: The Karlsson-Peterson scale showed a better performance than the AOFAS scale in the clinical and functional evaluation of patients with ankle instability treated with MBG plasty and suture tape augmentation. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.
... Varus and valgus angles also indicate the stability of ankle. Poor postoperative recovery was defined as AOFAS score < 80 [17]. Postoperative ROM limitation was defined as ankle plantarflexion + dorsiflexion ≤ 30 degrees [18]. ...
Background:
This study is aimed at exploring the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR), an index of systemic inflammation before operation, in ankle lateral ligament repair (ALLR).
Methods:
A total of 213 I-III degrees injuries of lateral ankle ligament patients received ALLR and were followed up for more than 2 years. Univariate and multivariable linear regression analysis was used to determine the relationship between preoperative LMR and postoperative recovery. The evaluations of postoperative recovery include American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson-Peter ankle score (KPAS), Cumberland Ankle Instability Tool (CAIT) score, Visual Analog Scale (VAS) score, and range of motion (ROM). The prognostic value of preoperative LMR was measured by receiver operating characteristic (ROC) curve.
Results:
178 patients (178 ankles) were followed up successfully, with a follow-up of 2.82 ± 1.54 years. Overall, the mean AOFAS, KPAS, CAIT and VAS scores, and ankle varus angle were significantly improved at the final follow-up. Univariate and multiple linear regression analysis showed that preoperative LMR was the only independent factor associated with postoperative function, ROM, and pain. The preoperative LMR of patients with poor recovery was significantly lower than that of patients with good recovery. Based on the ROC analysis, the cutoff value of preoperative LMR was 3.824. The clinical outcomes of patients with preoperative LMR < 3.824 were significantly lower than that of patients with preoperative LMR ≥ 3.824. The corresponding specificity and sensitivity were 84.6% and 71.4%.
Conclusion:
The clinical outcomes of open or arthroscopic repair for ATFL injury are satisfactory. As a marker of systemic inflammation, preoperative LMR can be used as a prognostic indicator for ALLR.
