SLR - October 2017 - Timothy P. McConn
Reference: Li H, Hua Y, Li H, Ma K, Li S, Chen S. Activity Level and Function Two Years After Anterior Talofibular Ligament Repair: A Comparison Between Arthroscopic Repair and Open Repair Procedures. Am J Sports Med. 2017 April; 45(9).Scientific Literature Review
Reviewed By: Timothy P. McConn, DPM
Residency Program: The Western Pennsylvania Hospital, Pittsburgh, PA
Podiatric Relevance: Ankle sprains are one of the most common musculoskeletal injuries treated by foot and ankle surgeons consisting of 23,000 ankle injuries per day and two million sprains per year in the United States. Eighty percent of these acute injuries will resolve with conservative treatment; however, 20 percent will go on to chronic lateral ankle instability, often requiring surgical intervention. Broström originally described a direct anatomic repair of the native anterior talofibular ligament (ATFL). Gould later described a modification of this technique, which incorporated the inferior extensor retinaculum. Surgeons are now offering to perform this procedure though an arthroscopic approach that decreases the size of the incision and allows for earlier weightbearing and a quicker return to function.
Methods: From January 2012 to August 2014, all patients who underwent open or arthroscopic Broström repair were reviewed for the study. Patients were assessed both preoperatively and postoperatively with AOFAS scores, KAFS scores and Tegner activity scores.
Results: A total of 60 patients were included in the study. Twenty-three patients underwent arthroscopic repair and 37 in the open repair group. All outcome measures increased significantly postoperatively for both groups; however, there was no significant difference between the two groups when compared.
Conclusions: When comparing open and arthroscopic lateral ankle ATFL repair, the study found there to be no difference in outcomes at two years postoperatively. However, one must consider return to activity and patient satisfaction in the more acute setting. At two years follow-up, it is to be expected that these two cohorts would level out at a functional level; however, in this study, all patients were kept nonweightbearing for four weeks. The purpose of an arthroscopic approach is to have patients weightbearing earlier and returning to activity levels at a quicker rate. Nonetheless, the study provides information that long term, there may be no difference in functional outcome when comparing the two different procedures.