2-3 Year Retrospective Audit of Arthroscopic ‘Internal Brace’ For Chronic ATFL Injury

Abstract

Category: Arthroscopy Introduction/Purpose: The aim of this audit is to present the surgical technique and medium term outcomes (2-3 years) of arthroscopic reconstruction of the anterior talo-fibular ligament (ATFL) using the Arthrex InternalBraceTM system. Acute lateral ligament injuries of the ankle respond well to early functional rehabilitation with physiotherapy and can have excellent results. For patients who develop chronic lateral ligament, the morbidity can be significant. Multiple surgical techniques for repair or reconstruction of the anterior talo-fibular ligament (ATFL) have been described. Protracted immobilization is often required in the post-op protocol. Short term outcomes (six months), for arthroscopic reconstruction of the anterior talo-fibular ligament (ATFL) using the Arthrex InternalBraceTM system, have previously been presented. The majority of patients reported good or excellent recovery. Methods: A similar cohort of patients to the short term (six months group) were identified. Adults aged between 18 and 65, average age 42. Exhausted conservative treatment. Clinical assessment and MRI scan confirmed torn/stretched/abnormal ATFL and no other significant pathology. Surgery was performed by a single surgeon Pre-operative questionnaire was completed on the day of surgery. (AOFAS, MOXFQ, EDQ-5, Visual Analogue Score) Surgery was performed as Day case with General anaesthetic and popliteal block. Antibiotics were given at induction. Anterior ankle arthroscopy performed through 2 standard anterior portals. +ve drive through confirmed. Arthroscopic stabilisation with Arthrex InternalBraceTM System:- 3.5 mm BioComposite SwiveLock with FiberTape placed into fibula with the distal end of FiberTape passed through 4.75 mm BioComposite SwiveLock / FibreTape (InternalBraceTM) placed into the talar neck. Post-op mobilisation in a moonboot for 7-10 days. Commence physiotherapy at 10 days. Biomechanical podiatric assessment at 6 weeks. Called for FU assessment at 2 years. Results: In the short term FU group, the majority of patient (13 of 17) reported that they were satisfied or very satisfied with the results of there surgery, with 10 of 16 stating that the surgery gave good, very good or excellent pain relief. The majority of patients (12 of 16) would definitely have the surgery again. Review at two years of clinical notes for patients who previously had surgery for ATFL injury with InternalBraceTM. Patients with other pathologies were excluded. This gave a similar cohort to the six month review patients. All patients were contacted for FU by an ESP Podiatrist and invited to come for clinical review. Only 3 patients reported on-going issues with pain, 1 of which requires revision surgery. Conclusion: Arthroscopic ATFL repair using an InteralBraceTM allows early post-operative rehabilitation with accelerated fully weight bearing rehabilitation. This audit would suggest that the short-term positive results are maintained into the medium term at 2-3 years. The long term outcome is currently not known due to this being a relatively new procedure. This method of ATFL repair could have great potential for elite athletes but also for ‘every day’ patients who still desire to have a rapid return to normal function.