Outcomes of a Modified Arthroscopic-assisted Reconstruction Technique for Lateral Ankle Instability

Abstract

Objective The present study assesses the results of a minimally invasive surgical technique for acute and chronic ankle instability management. Methods The present case series study retrospectively evaluated 40 patients undergoing arthroscopic-assisted percutaneous ankle ligament reconstruction from 2013 to 2019. Results The present study included 17 males and 23 females with an average age of 38.3 years old. Postintervention follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores identified improvement of > 30 points in function and pain control. The most frequently occurring associated injuries were osteochondral (35%). No patient required reintervention or had infection during follow-up. Conclusion The technique in the present study is easy and achieves satisfactory results for function and pain control. Level of Evidence IV.

Keywords: ankle joint; arthroscopy; joint instability; ligaments, articular; subtalar joint; tendons.

Fig. 1

Radiologic anterior-drawer test. Note forward talar displacement in the image on the right.

Fig. 2

Patient positioning with traction device.

Fig. 3

( A ) Chondral lesion identification and removal with radiofrequency. ( B ) Synovium removal with shaver blade. ( C–D ). Lateral instability assessment with joint tester, displacing the fibula laterally in the distal tibiofibular joint in the lateral recess (Left: talus. Right: fibula. Up: tibia). ( E–F ). Anchor fixation in a point previously marked through the anterolateral accessory portal.

Fig. 4

( G-H ) Lateral ligament complex reconstruction with extensor retinaculum. ( I-J ). Percutaneous anchor pass and retrieval through incisions and anterolateral port suture knot tying through lateral incision (Asterisk: lateral skin incision).

Fig. 5

Evolution of AOFAS score after surgery.

Fig. 6

Pain reported by patients before and after surgery.

Fig. 1

Teste radiológico de gaveta anterior. Observe o deslocamento talar para a frente na imagem à direita.

Fig. 2

Posicionamento do paciente com dispositivo de tração.

Fig. 3

( A ) Identificação e remoção da lesão condral com radiofrequência. ( B ) Remoção sinovial com lâmina. ( C-D ). Avaliação lateral de instabilidade com testador articular, deslocando a fíbula lateralmente na articulação tibiofibular distal no recesso lateral (Esquerda: talo. Direito: fíbula. Para cima: tíbia). ( E-F ). Fixação de âncora em um ponto previamente marcado através do portal auxiliar anterolateral.

Fig. 4

( G-H ) Reconstrução do complexo do ligamento lateral com retináculo extensor. ( I-J ). Passagem percutânea de âncora e recuperação através de incisões e nó de sutura do portal anterolateral amarrando-se através da incisão lateral (Asterisco: incisão lateral da pele).

Fig. 5

Evolução da pontuação AOFAS após a cirurgia.

Fig. 6

Dor relatada pelos pacientes antes e depois da cirurgia.