SLR - November 2017 - Jamey A. Allen
Reference: Li H, Hua Y, Li H, Ma K, Li S, Chen S. Activity Level and Function 2 years after Anterior Talofibular Ligament Repair: A Comparison Between Arthroscopic Repair and Open Repair Procedures. Am J Sports Med. 2017 July 45(9): 2044–2051.Scientific Literature Review
Reviewed By: Jamey A. Allen, DPM
Residency Program: Cambridge Health Alliance, Cambridge, MA
Podiatric Relevance: Ankle sprains and tears to the anterior talofibular ligament (ATFL) are commonly encountered injuries in podiatric clinics. The majority of patients improve with conservative care. When surgical intervention is indicated for patients, a more minimal incision approach provides greater benefits, including a reduced incision, minimized scar formation and potential to return to activities earlier. There has been literature evaluating the viability of arthroscopic repairs; however, prior to this article, no comparison has been performed. The authors set out to evaluate the repair of the ATFL comparing the arthroscopic and open repair using questionnaires, MRI evaluation and ability to perform sport activities.
Methods: The authors performed a retrospective review of patients over a 2.5-year span with a total n=60 with 23 undergoing arthroscopic repair and 37 patients requiring an open repair. All patients underwent ankle arthroscopy where the ATFL was evaluated. Intraoperatively, the decision was made as to if it was possible to repair the ATFL either via arthroscopic approach or if the procedure needs to be performed with an open Broström repair. All patients were followed for at least two years with AOFAS, KAFS and Tegner activities score subjective questionnaires filled out by the patients. Anterior drawer tests were performed on the same day as the MRI. The MRI was used to compare the signal-noise ratio, which can indirectly show ligament function. The MRI reader was blinded to type of operation and repeated to calculate intraobserver reliabilities.
Results: No statistical significance was found between age, BMI, injury time, sex, AOFAS, KAFS or Tegner activities score between the two groups. All patients, except for three, had an increase in AOFAS, KAFS and Tegner activity score. Those three patients, one in the arthroscopic and two in the open group reported no improvement of functional scores. All three of the patients had a medial OCD that underwent microfracture. No patient underwent revision of lateral ligament surgery. Thirty-seven patients underwent MRI scan, 14 in the arthroscopic and 23 in the open group. No patients had ATFL tear, and there was no significant difference between the signal to noise ratio between the groups.
Conclusions: Prior to this article, no direct comparison between arthroscopic and open repair of the ATFL has been performed. This study is limited with not addressing CFL injury. An additional limitation is open repair was only performed when arthroscopic could not be performed and did not directly compare the outcome. This article shows arthroscopic repair, in the appropriate setting, can be a viable option for patients. Arthroscopic repair can limit the operation time, reduce the incidence of postoperative adhesions created with a larger incision and lead to a faster recovery time.