Anatomical reconstruction produced similarly favorable outcomes as repair procedures for the treatment of chronic latera
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Anatomical reconstruction produced similarly favorable outcomes as repair procedures for the treatment of chronic lateral ankle instability at long-term follow-up Hong Li1 · Yinghui Hua1 · Hongyun Li1 · Shiyi Chen1 Received: 18 June 2018 / Accepted: 21 September 2018 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018
Abstract Purpose The aim of this study was to compare long-term outcomes after anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) repair and reconstruction at 5–10 years after surgery. Methods Forty-five patients who underwent surgical repair or reconstruction of both ATFL and CFL were retrospectively investigated in this study. American Orthopedic Foot and Ankle Society (AOFAS), Karlsson Score, and Tegner activity scale were used to evaluate the ankle function at a follow-up of 5–10 years. Ultrasound examination was used to evaluate the ATFL and CFL, and MRI was used to evaluate the cartilage. Results At final follow-up, no patient had recurrent ankle instability. There were no significant differences in AOFAS (92.6 ± 6.5 vs 89.6 ± 3.4; n.s.) or Karlsson Score (93 ± 8.2 vs 90.6 ± 5.0; n.s.) between the reconstruction group (twenty patients) and the repair group (twenty-five patients) postoperatively. There were also no significant differences in activity level as measured by the Tegner activity score (6 (range 4 to 8) vs 6 (range 5 to 7); n.s.). Five patients in the reconstruction group complained of some tightness of the ankles. Ultrasound showed the reconstructed ligaments maintained good continuity and were thicker than the repaired ligaments. Conclusion Patients in both the repair and the reconstruction cohort had high patient satisfaction with the outcomes and high function and activity levels that indicated recreational sports participation over a long period. Level of evidence III. Keywords Ankle instability · ATFL · CFL · Repair · Reconstruction
Introduction Ankle sprain is one of the most common sports activity injuries [2, 20, 24]. It often results in rupture of the ankle’s lateral collateral ligaments, primarily the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) [19]. The injured ankle may gradually develop chronic lateral ankle instability (CAI) [5, 21]. Traditionally, the modified Broström anatomic repair technique has been suggested as the gold standard for the treatment of CAI [1, 15]. Even with successful repair of ATFL and CFL, some patients still did * Yinghui Hua [email protected] 1
Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai 200040, People’s Republic of China
not feel safe with their ankles because of new episodes of ankle instability [11, 17]. Maffulli et al. [17] investigated 34 patients at an average of 8.7 years after Broström repair surgery, and found that 58% of patients returned to sports at the preinjury level, and 6 patients had recurrent ankle instability. To avoid recurrent instability, anatomic augmented reconstruction with a tendon
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