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. 2021 Mar 8;6(1):2473011420986150.
doi: 10.1177/2473011420986150. eCollection 2021 Jan.

Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability

Nacime Salomão Barbachan Mansur  1 , André Vitor Kerber Cavalcante Lemos  1 , Daniel Soares Baumfeld  2 , Tiago Soares Baumfeld  2 , Marcelo Pires do Prado  3 , Fernando Cepolina Raduan  1 , Caio Augusto Souza Nery  1
Affiliations

Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability

Nacime Salomão Barbachan Mansur et al. Foot Ankle Orthop. .

Abstract

Background: The high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Persistence of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability.

Methods: This is a retrospective study with patients diagnosed with multidirectional instability who underwent ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the visual analog scale (VAS) score and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score at a mean of 14.8 months (5-27 months) in follow-up. A total of 30 ankles (29 patients) were included in the study.

Results: The AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean (P = .001) and was followed by significant improvement in the mean VAS score (6.8, CI 0.37-0.95, CI 0.31). The majority of patients had associated procedures (53.3%), and a low complication rate was found (16.6%).

Conclusion: Combined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique may improve the clinical outcomes of these patients.

Level of evidence: Level IV, retrospective case series.

Keywords: ankle injuries; collateral ligaments; joint instability; lateral ligament.

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Conflict of interest statement

Ethics Approval: University Ethics Committee approved this research under the number 32854720.8.0000.5505 in accordance with the Declaration of Helsinki. Protocol registration was executed at the Clinical Trials database under the protocol number NCT04459910. Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
Lateral anchor insertion at the lateral malleolus as described by Nery et al and Acevedo and Mangone.
Figure 2.
Figure 2.
Medial anchor insertion at the medial malleolus quadrant as described by Vega et al.
Figure 3.
Figure 3.
Sutures are passed using an inside-out technique for both ligament complexes. A “Spider Web” configuration is obtained and arthroscopic knots implemented.
Figure 4.
Figure 4.
Weightbearing anteroposterior ankle radiograph from a patient submitted to the described technique and 12 months of follow-up.
Figure 5.
Figure 5.
American Orthopaedic Foot & Ankle Society (AOFAS) Ankle scores preoperatively and postoperatively in all subjects and in specific subgroups. All P < .005.
Figure 6.
Figure 6.
Visual analog scale (VAS) scores preoperatively and postoperatively in all subjects and in specific subgroups. All P < .005.
See this image and copyright information in PMC

References

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