Arthroscopic Four-Step Treatment for Chronic Ankle Instability

Abstract

Background: Chronic lateral ankle instability is a condition of perception of giving way and persistent pain usually following multiple ankle sprains. Open reconstructive procedures carry the disadvantages of subtalar joint stiffness and potential morbidity at the harvesting site. Recently, arthroscopic treatment of chronic lateral ankle instability has been proposed in order to minimize invasiveness, reduce operating time, and allow a faster rehabilitation period. The purpose of our paper was to assess the outcomes in terms of postoperative recovery and return to sport following arthroscopic reconstruction of lateral ankle instability. Methods: Ninety patients with chronic lateral ankle instability were treated at our Department from 2004 to 2009. Mean age was 32.4 (range, 17 to 56) years. All patients underwent a four-step operative procedure, including: synovectomy, debridement of ATFL lesion borders, capsular shrinkage, and 21-day immobilization and nonweightbearing. Results: Followup examination at an average of 4 years after surgery showed significant improvement of mean AOFAS scale (preoperative, 63.5; postoperative, 92.3; p < 0.001) and average Karlsson score (preoperative, 61.8; postoperative, 88.4; p < 0.001). Mean Tegner rating changed from 3.6 preoperatively to 4.9 at followup ( p < 0.001). Articular stability as assessed by Sefton scale significantly improved from a preoperative value of 4.0 to 1.8 ( p < 0.001). Most patients (96.6%) rated the success of their surgery as good to excellent. Conclusion: Based on our results, we propose arthroscopic treatment as a suitable option for moderate chronic ankle joint laxity in patients with a complete ATFL lesion.Level of Evidence: IV, Retrospective Cohort Study