SLR - April 2020 - Elvis Danne Jr.
Reference: Li, H., Hua, Y., Li, H.et al. Anatomical Reconstruction Produced Similarly Favorable Outcomes as Repair Procedures for the Treatment of Chronic Lateral Ankle Instability at Long Term Follow Up. Knee Surg Sports Traumatol Arthrosc (2018, Oct, 5). https://doi.org/10.1007/s00167-018-5176-zScientific Literature Review
Reviewed By: Elvis Danne Jr., DPM
Residency Program: Northwell Health Long Island Jewish Forest Hills Hospital – Queens, NY
Podiatric Relevance: Ankle sprains are one of the most common sports injuries. Patients with recurrent ankle sprains often develop chronic lateral ankle instability and commonly present to the foot and ankle surgeon for surgical repair or reconstruction. This article compares long-term outcomes after anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) repair versus reconstruction at 5-10 years after surgery and hypothesizes that reconstruction will have similar results at long term follow up compared to the repair group.
Methods: This is a level III retrospective study investigating 45 patients who underwent surgical repair or reconstruction of both the ATFL and CFL using the AOFAS, Karlsson Score and Tegner activity scale to evaluate ankle function at follow up of 5-10 years with a mean follow up time of 81 +/- 10 months for the repair group and 87 +/- 18 months for the reconstruction group. Twenty patients underwent reconstruction and 25 underwent open Broström repair. Each procedure began with arthroscopic evaluation. Repair was considered for patients with sufficient remnant tissue and reconstruction was considered for patients with previous failed ligament repair, poor tissue quality, generalized ligamentous laxity, high demand activity and overweight patients. The post-operative protocol differed for each group, however strenuous activity and contact sports were not allowed until 12 months after surgery in both groups. Ultrasound was used to evaluate the ATFL and CFL postoperatively. MRI used to evaluate the ankle joint cartilage.
Results: Postoperatively there was a significant increase in AOFAS score, Karlsson Score, and Tegner activity score in both groups. There were no significant differences in AOFAS or Karlsson Scores between the reconstruction group and the repair group postoperatively. At final follow up, no patient had recurrent ankle instability and the anterior talus translation was normal to all ankles. No significant difference of ankle range of motion was detected between the operated ankle and the contralateral healthy ankle in each group. There were no significant differences in activity level as measured by the Tegner activity score. Five patients in the reconstruction group complained of some tightness in the ankles with no ankle tightness reported in the repair group. Ultrasound showed the ATFL and CFL in the reconstruction group maintained good continuity and were significantly thicker than the repaired ligaments. MRI revealed no osteophytes in the tibiotalar joint, and no osteoarthritis observed.
Conclusions: This study showed that both the repair group and the reconstruction group had high patient satisfaction and high function and activity levels at long term follow up. Anatomic reconstruction is more invasive but shows similar results to the anatomic repair and is a viable option in patients with insufficient native tissue, high demand athletes, ligamentous laxity patients, previous repair failure, and overweight patients where an anatomic repair will not suffice.