Abstract
BackgroundThe arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients.MethodsThis retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups.ResultsIncrease in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups.ConclusionIn patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome.Level of EvidenceLevel III, a retrospective comparative study.
Highlights
The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI)
Patient selection Inclusion criteria were as follows: (1) CLAI patients with no improved symptoms after 6 months of conservative management; (2) patients who had undergone unilateral ankle arthroscopic modified Broström procedure with one double-loaded suture anchor fixation (Fastin RC 3.5 mm, Smith & Nephew, Andover, MA); (3) a preoperative magnetic resonance imaging of the ankle showed medial Osteochondral lesions of the talus (OLTs) or no OLTs; (4) OLTs located in the medial portion of the talus, with a diameter no greater than 15 mm in diameter and a depth no greater than 8 mm; (5) follow-up for at least 24 months with complete surgical and follow-up data; (6) all procedures were performed by the same senior foot and ankle surgeon with extensive experience in arthroscopy, who was not involved in postoperative follow-up
Results were comparable for Visual Analogue Scale (VAS), AOFAS, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), and Active Joint Position Sense (AJPS) at 1 year and 2 years (Table 2)
Summary
The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs) It remains unclear whether associated limited OLTs affect clinical outcomes in such patients. Chronic lateral ankle instability (CLAI) can be associated with osteochondral lesions of the talus (OLTs), which occur in up to 70% of acute ankle sprains and associated fractures [1]. Arthroscopic repair of the lateral ankle ligamentous complex and management of intra-articular lesions of the ankle are routinely performed [14]. It is unclear whether the presence of OLTs affects the outcome of the stabilization procedure
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