Abstract
PurposeThe Broström-Gould procedure, with the repair of the anterior talofibular ligament (ATFL) combined with the transfer of the extensor retinaculum, is considered the gold standard procedure for the management of chronic lateral ankle instability (CLAI). Lateral ligament reconstruction is considered if the ATFL remnant quality is poor or the ATFL has been damaged beyond the ability to suture it. It remains unclear whether not repairing the ATFL remnant produces comparable functional outcomes to the classical Broström-Gould procedure.MethodsThis retrospective cohort study included 84 patients with CLAI undergoing either repair or non-repair of the ATFL remnant using an all-inside arthroscopic Broström-Gould procedure from 2015 to 2018. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups.ResultsAll the functional scores (VAS, AOFAS, KAFS, ATT, AJPS) significantly improved in both groups at 1 and 2 years after surgery. At all the follow-up time points, the VAS, AOFAS, KAFS, ATT, AJPS, and the rate of return to sport scores were comparable between the repair and non-repair group.ConclusionThere are no statistically significant differences in postoperative outcomes between ATFL remnant repair and non-repair for the management of CLAI using the all-inside arthroscopic Broström-Gould procedure. From the clinical viewpoint, the present study shows that the potential differences in clinical outcomes between ATFL remnant repair and non-repair are likely not relevant when performing an all-inside arthroscopic Broström-Gould procedure for CLAI.Level of evidenceIII.
Highlights
Inversion injury is the most frequent ankle injury [5], with the anterior talofibular ligament (ATFL) [7] especially at risk
The Broström-Gould procedure, with the repair of the ATFL combined with the transfer of the extensor retinaculum, is considered the gold standard procedure for the management of chronic lateral ankle instability (CLAI) [22, 25]
Debridement of the synovial tissue of the ankle joint was performed in all patients, and microfracture of the talus was performed in 31 patients (18 in the repair group vs 13 in the non-repair group)
Summary
Inversion injury is the most frequent ankle injury [5], with the anterior talofibular ligament (ATFL) [7] especially at risk. Surgery should be considered for patients with symptomatic ankle instability and repeated ankle sprains despite appropriate conservative management for 3–6 months [20]. The Broström-Gould procedure, with the repair of the ATFL combined with the transfer of the extensor retinaculum, is considered the gold standard procedure for the management of chronic lateral ankle instability (CLAI) [22, 25]. In this procedure, following repair of the ATFL, the extensor retinaculum is used to reinforce the lateral ankle ligament complex [18]. There could be differences in functional outcomes between repairing or not repairing the ATFL remnant using the Broström-Gould procedure. There are no prior reports comparing the two approaches with respect to ankle function and stability outcomes
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