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. 2022 Nov 19;17(1):502.
doi: 10.1186/s13018-022-03402-z.

Functional outcomes of all-inside arthroscopic anterior talofibular ligament repair with loop suture versus free-edge suture

Shi-Ming Feng #  1 , Chang-Qing Shao #  2 , Qing-Qing Sun  2 , Francesco Oliva  3 , Nicola Maffulli  4   5   6
Affiliations

Functional outcomes of all-inside arthroscopic anterior talofibular ligament repair with loop suture versus free-edge suture

Shi-Ming Feng et al. J Orthop Surg Res. .

Abstract

Background: Anatomic repair of anterior talofibular ligament (ATFL) is used to manage chronic lateral ankle instability (CLAI). However, the optimal suture configuration used to repair the ATFL is not yet determined. It remains unclear whether suture configuration affects clinical outcomes in such patients.

Purpose: To compare the functional outcomes of all-inside arthroscopic ATFL repair using either a loop suture and or a free-edge suture configuration in CLAI patients.

Study design: Cohort study; Level of evidence, 3.

Methods: This retrospective cohort study included 71 patients with CLAI who had undergone an all-inside arthroscopic ATFL repair procedure with either loop suture (n = 36) or free-edge suture (n = 35) from February 2016 to July 2018. Comparable pre-operatively, the Visual analogy score (VAS), American Orthopedic Foot and Ankle Society scoring system (AOFAS), Karlsson Ankle Functional Score (KAFS) scoring system, Anterior Talar Translation (ATT) and Active Joint Position Sense (AJPS) were used to evaluate postoperative ankle function.

Results: There were no postoperative wound complications, implant reactions, or neurological or vascular injuries. Postoperative hospitalization, VAS, AOFAS, KAFS, AJPS and the time of return to sport were similar between the loop suture group and free-edge suture group. Requiring a longer procedure time, patients with loop suture configuration achieved better ATT.

Conclusion: All-inside arthroscopic ATFL repair procedure for CLAI treatment provides better ATT and comparable functional outcomes when a loop suture configuration is used instead of a free-edge suture configuration. A statistical difference in ATT was observed. Given the relatively short follow-up, it is questionable whether this will have any clinical relevance.

Keywords: Arthroscopic anterior talofibular ligament repair; Chronic lateral ankle instability; Free-edge suture; Loop suture.

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Conflict of interest statement

None of the authors has any commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article.

Figures

Fig. 1
Fig. 1
ATFL injury confirmed at the magnetic resonance imaging (A) and arthroscopy (B)
Fig. 2
Fig. 2
Flow diagram of the study
Fig. 3
Fig. 3
Surgical diagrams of all-inside arthroscopic ATFL repair with loop suture configuration (one suture arm sutured). A and B: one suture arm (purple) was passed through the distal ATFL remnant and a loop was created in the lateral gutter. C and D: the free end of the suture arm (purple) was passed through the created loop, and the ATFL would be self-cinching sutured when the free suture arm was pulled
Fig. 4
Fig. 4
Surgical diagram of all-inside arthroscopic ATFL repair with loop suture configuration (two suture arms sutured)
Fig. 5
Fig. 5
Surgical diagram of all-inside arthroscopic ATFL repair with free-edge suture configuration
See this image and copyright information in PMC

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