SLR - November 2020 - Kathryn T. Cecere
Reference: Cordier, Guillauma et al. " Endoscopic Anatomic Ligament Reconstruction is a Reliable Option to Treat Chronic Lateral Ankle Instability". Knee Surgery, Sports Traumatology, Arthroscopy, 28, November 2019, pp. 86-92. Springer Link, doi.org/10.1007/s00167-019-05793-9. Accessed 20 September 2020.Scientific Literature Review
Reviewed By: Kathryn T. Cecere, DPM
Residency Program: University of Florida Health – Jacksonville, FL
Podiatric Relevance: Ankle sprains, specifically inversion sprains affecting the ATFL and CFL, are among the top injuries seen within the lower extremity. Surgical techniques consisting of anatomic repair and reconstruction are favorable as they provide the highest success rates with low complications. More recently, there is an increase in minimally invasive techniques within foot and ankle surgery. The purpose of this study was to evaluate outcomes following an all-inside ankle, lateral ligament endoscopic autograft reconstruction with at least 2 year follow up. The authors hypothesize that this technique offers a good functional outcome with a low risk of complications.
Methods: 53 patients, with a minimum follow up of 2 years, underwent endoscopic lateral ligament reconstruction. Each patient sustained a lateral ankle sprain and presented with a positive anterior drawer. Ultrasound confirmed complete rupture of the ATFL and complete or partial rupture of the CFL. All surgical procedures were performed by a single surgeon using the standardized technique. The first step was the arthroscopic procedure where all lesions were treated and the ATFL and CFL insertions identified. The autograft was then harvested from the gracilis tendon. A third portal was created just above the sinus tarsi to use as a working portal in order to expose the talar and calcaneal footprints of the ATFL and CFL. The first tunnel was drilled from the calcaneal footprint to the anterior medial edge of the calcaneal tuberosity and the second was drilled in an oblique fibular fashion. The graft was introduced through the second portal and fixated with a Tenodesis Screw. The other end of the graft was received in the third portal and passed through the endobutton. The button was placed on the retromalleolar side of the fibula and the graft passed through the calcaneal tunnel and fixated using an interference screw.
Results: At final follow up the AOFAS and VAS score improved from preoperative to postoperative status. While there was a significant loss of range of motion about passive dorsiflexion and plantarflexion of the ankle joint, no patient reported dissatisfaction with this outcome. All but 2 patients reported disappearance of their preoperative ankle instability. Post-operatively 31 of 35 patient returned to their respective sport activity with 26 of them returning at the same level.
Conclusions: This study shows that endoscopic repair is a safe and reliable surgical method to treat lateral ankle instability. This distinctive technique allows for treatment of intraarticular lesions while also allotting for anatomic repair using a minimally invasive technique. The endoscopic method also helps with assessing the remaining surrounding ligamentous and soft tissue structures. Since this is a minimally invasive technique, there is lower risk to soft tissue damage which allows for shorter recovery time. While technically more demanding, this novel technique allows for treatment of both the ATFL and CFL.