A four-step approach improves long-term functional outcomes in patients suffering from chronic ankle instability: a retr

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A four‑step approach improves long‑term functional outcomes in patients suffering from chronic ankle instability: a retrospective study with a follow‑up of 7–16 years Alberto Ventura1   · Enrico Borgo1 · Clara Terzaghi2 · Vittorio Macchi1 · Claudio Legnani1  Received: 22 April 2020 / Accepted: 5 November 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020

Abstract Purpose  The aim of the present study was to assess the long-term outcomes of the treatment of chronic ankle instability (CAI) with a four-step protocol. Methods  Fifty-four patients with isolated anterior talo-fibular ligament (ATFL) lesion suffering from CAI who underwent surgical treatment between 2000 and 2009 were assessed. All the patients underwent a four-step protocol including synovectomy, debridement of ATFL lesion borders, capsular shrinkage, and 21-day immobilization and nonweightbearing. Median age at surgery was 31.6 years (18–48). Patients were examined preoperatively and at follow-up. Clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system, Karlsson–Peterson score, Tegner activity level, and objective examination comprehending range of motion (ROM) and manual laxity tests. Results  AOFAS (preoperative, 64.8; postoperative, 92.4; p