Reconstruction ligamentaire anatomique endoscopique pour traiter l’instabilité latérale chronique de la cheville chez les plus de 50 ans : étude comparative entre des séries de patients de plus de 50 ans et de moins de 30 ans

Abstract

The purpose of this study was to compare the patient-reported outcomes, patient satisfaction, and failure rates in patients older than 50 years who underwent anterior talofibular ligament and calcaneofibular reconstruction, and to compare these results with those obtained from a younger patient group (age 20–30 years). A retrospective analysis of prospectively collected data was performed. All patients undergoing a primary ATFL-CFL reconstruction between 2015 and 2018 by a single surgeon were collated. Patients were divided into 2 groups based on age at the time of surgery: a younger cohort (20–30 years) and an older cohort (50–75 years). Eighteen patients older than 50 years and 42 patients younger than 30 years who underwent ligament reconstruction were retrospectively studied. Patients were excluded if they were outside the desired age intervals; had revision ATFL-CFL reconstructions; underwent prior alignment. The visual analogue score (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Karlsson–Peterson scores, and rate of secondary arthrofibrosis surgery were documented at a minimum 2-year follow-up and were compared between groups. The groups were comparable at the baseline. After an average follow-up of 38.5 ± 8.8 months, both groups had significant improvements in all parameters, AOFAS score, Karlsson–Peterson score, and VAS score, at 2-year postoperatively (all P < 0.05). Compared with younger patients, older patients had similar results for Karlsson–Peterson score and VAS score (n.s.). However, younger patients had better AOFAS score than did older patients [median 93,4 vs. median 88, P = 0.018]. Though with lower AOFAS score, older patients with ATFL-CFL reconstruction had comparable results to younger patients. ATFL-CFL reconstruction is recommended for treating patients older than 50 years with chronic lateral ankle instability, especially for those with high functional demand.