SLR - December 2023 - George
Title: Both Open and Arthroscopic All-Inside Anatomic Reconstruction With Autologous Gracilis Tendon Restore Ankle Stability in Patients With Chronic Lateral Ankle InstabilityReference: Su T, Wang AH, Guo QW, Zhu YC, Jiang YF, Hu YL, Jiao C, Jiang D. Both Open and Arthroscopic All-Inside Anatomic Reconstruction With Autologous Gracilis Tendon Restore Ankle Stability in Patients With Chronic Lateral Ankle Instability. Arthroscopy. 2023 Apr;39(4):1035-1045. doi: 10.1016/j.arthro.2022.11.035. Epub 2022 Dec 8.
Reviewed By: Dr. Thomas George Jr DPM
Residency Program: John Peter Smith Hospital, Fort Worth Texas
Podiatric Relevance: Ankle sprains are one of the most common injuries amongst physically active individuals. Without proper treatment, a high percentage of these patients have functional and mechanical deficits leading to chronic lateral ankle instability (CLAI). The goldstandard for ankle instability has been the Brostrom and its modifications in the open approach. Arthroscopy has improved over the past few years with favorable clinical outcomes as well. This article provides a comparison between open and arthroscopic approaches for lateral ankle reconstruction.
Methods: This study took place between March 2018 and January 2020. After institutional review board approval all participants indicated for lateral ankle reconstruction provided informed consent before study inclusion and assessed for eligibility. Inclusion criteria included traumatic history of at least one ankle sprain, persistent clinical symptoms of instability, failure of conservative care, MRI evidence of attenuation or defect of ATFL or CFL, positive anterior drawer. Exclusion criteria included previous ankle surgery, ankle arthritis, OCDs (larger than 1.5 cm), deltoid or peroneal tendon injury, neuromuscular disorder. Randomization was achieved through an envelope system. Each eligible patient was allocated to open or arthroscopic anatomic reconstruction of the lateral ankle in a 1:1 ratio.
Results: All the patients were followed up at 3, 6, 12, and 24 months after operation. There was no significant difference in preoperative characteristics between the 2 groups. The VAS pain score andAOFAS score all improved significantly at 2-year follow-up in both groups from baseline. In regard to return to activities, patients in the arthroscopic group required significantly shorter time to restore full weightbearing walking than open group
Conclusions: The most important finding of this study was that, compared with the open procedure, arthroscopic all-inside anatomic lateral ankle ligament reconstruction with autologous gracilis tendon could achieve earlier return to full weightbearing walking, jogging, and recreational sports with less pain and better ankle functional scores at 3 to 6 months after surgery. Similar favorable clinical outcomes were achieved for both techniques at 2 years after operation. This finding indicated that the arthroscopic all-inside technique could be a satisfactory choice of surgical management for CLAI patients with insufficient local tissue remnant.