Arthroscopic ATFL ligament reinforcement: a case series

S. Yousufuddin, S. Ali, A. Usman

Introduction: Ankle inversion injuries are incredibly common, but often suboptimally managed with up to 30% of patients have long-term instability. Approximately 85% of ankle sprains involve lateral ligament complex. Some controversy still persists regarding the best modality of the surgical treatment. We present a case series and pragmatic approach to lateral complex injuries by arthroscopic reinforcement. Arthroscopic assisted surgical repair has an advantage of early recovery and consistent improvement in functional score of the patients.

Method: Via our single consultant trauma clinic we evaluated and followed-up consecutive patients between the ages of 18 and 50 presenting with ankle instability over six months. Patients underwent focused rehabilitation (minimum 3 months) and identification of extent of ligament injury using dynamic ultrasound scanning (DUSS) at 7.2 weeks post injury (a point at which ankle pain had settled down). Patients with residual pain and instability after 3 months were considered to have failed conservative management. A subsequent MRI scan was performed to determine other ankle pathologies such as osteochondral and peroneal tendon lesions. AFOAS Scores were performed at 6 weeks from index injuries and 3 months following surgery. Patients underwent arthroscopic assessment and simultaneous arthroscopic-assisted anterior talofibular ligament (ATFL) repair using a biodegradable suture anchor in the fibula and 4-strand suture at the talar insertion.

Results: Thirty-eight patients were identified and 34 included in the study. The 4 excluded patients had either significant associated injuries or were non-compliant with post-op follow-up. The AOFAS score (median (interquartile range)) improved from 66 (53-68) pre-operatively to 90(85-92) post-operatively. Twelve patients had subcutaneous suture irritation for three months which resolved and one patient had neuropraxia of sural nerve. There were no cases of infection or over-tightened ligaments.

Conclusions: Our results demonstrate improvement in AFOAS Scores following the arthroscopic assisted ATFL repair with better patient satisfaction.