Clinical Outcomes of Arthroscopic Ankle Lateral Ligament Repair with Accelerated Rehabilitation

Abstract

Category: Arthroscopy; Ankle; Sports Introduction/Purpose: Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, many reports have described postoperative cast immobilization and the avoidance of weight-bearing for a certain period of time. Accelerated rehabilitation (AR), in which the period of immobilization is kept to a minimum and early weight-bearing exercises are actively introduced, may be helpful for an early return to sport. The purpose of this study was to investigate the therapeutic outcomes of ALLR with AR including the minimum duration of postoperative ankle immobilization and proactive early weight-bearing. Methods: A total of 23 ankles of 22 patients (11 men, 11 women; mean age 38.7 years) who underwent ALLR for chronic lateral ankle instability were investigated. Postoperative management included the avoidance of weight-bearing until postoperative day (POD) 3, after which full weight-bearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. Preoperative and postoperative major symptoms, ankle range of motion (ROM), stress X-ray assessment, anterior translation (AT) measured with a capacitance-type strain sensor, the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated. Results: Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in ROM. There were significant improvements in the mean talar tilt angle (from 12° to 5.6°), in the mean anterior drawer distance (from 8.2 mm to 4.4 mm) on stress X-rays, and in the mean AT (from 10.5 mm to 4.6 mm). The JSSF scale improved significantly (from 68.8 to 96.8), and the SAFE-Q improved significantly on all subscales. Complete return to sport was achieved by 75% of the patients at 8 weeks after surgery. Conclusion: When AR with proactive weight-bearing exercises was implemented from POD 3 without ankle immobilization after ALLR, there were significant improvements in both objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.