Arthroscopic stabilisation of the ATFL ligament of the lateral ligament complex of the ankle using Arthrex Internal Brace

R. Miller

Introduction: Lateral ligament complex injuries to the ankle are common. Patients with chronic injuries present with lateral ankle pain +/- instability. Radiographs frequently show no bony injury. There is often a delay for patients to be referred to the Orthopaedic Foot and Ankle Surgeon. Multiple surgical techniques for repair or reconstruction of the anterior talo-fibular ligament (ATFL) have been described, with varying post-operative rehabilitation regimens.

Aim: To assess the short term outcome of arthroscopic anterior talo-fibular ligament (ATFL) repair using the Arthrex InternalBraceTM system.

Methods: All patients had exhausted conservative treatment. Pre-operatively patients were assessed clinically and radiologically (x-ray and MRI scan). MRI confirmed torn/stretched/abnormal ATFL or if negative, very high clinical suspicion. Patients were then consented for arthroscopy + ATFL repair. Pre-operative questionnaire (approved by Scottish Foot and Ankle Surgeons): AOFAS, MOXFQ, EDQ-5, Visual Analogue Score. Day case: General anaesthetic with popliteal block. Antibiotics at induction. Anterior ankle arthroscopy performed through 2 standard anterior portals. Arthrex InternalBraceTM System: 3.5mm BioComposite SwiveLock with FiberTape placed into fibula Distal end of FiberTape passed through 4.75mm BioComposite Ankle plantarflexed to gain appropriate tension on the InternalBraceTM SwiveLock / FibreTape placed into the talar neck drill hole. Post-op mobilisation in a moonboot for 7-10 days. Commence physiotherapy at 10 days. Biomechanical podiatric assessment at 6 weeks. Telephone follow-up at 6 months PROMS.

Results: 14 patients reported pre-op instability with 16 patients stating moderate/severe pain on daily activity. Post-operatively 13 patients were satisfied or very satisfied with surgery. 10 reporting good/very good/excellent improvement in their pain scores. 12 patients stated that they would definitely have the surgery again. At six months, there were no post-operative infections or implant failures.

Conclusion: Arthroscopic ATFL repair with InteralBraceTM allows early post-operative rehabilitation fully weight bearing with high patient satisfaction