2023, Vol. 27 ›› Issue (13): 2064-2070

All-arthroscopic repair of anterior talofibular ligament with suture anchors versus InternalBrace for chronic lateral ankle instability

Zeng Guanglong, Xie Qingxiang, Li Yongcong, Su Boyuan   

Abstract: BACKGROUND: Anterior talofibular ligament is the most easily injured or even broken of ankle sprain. Patients who fail to receive conservative treatment after injury are often afraid of walking at night, resulting in persistent ankle swelling, painful, slack or stiff and functional decline that it is so-called chronic lateral ankle instability. InternalBrace repair is closer to the biomechanical structure of anterior talofibular ligament and become stronger lateral stability of ankle that it is helpful for chronic lateral ankle instability patients who need early recovery of activity.  
OBJECTIVE: To investigate feasibility and safety of all-arthroscopic repair of anterior talofibular ligament with suture anchors versus InternalBrace for chronic lateral ankle instability by prospective controlled study, analyze and compare its clinical efficacy, and provide patients with better and more satisfactory total arthroscopic treatment.
METHODS: From January 2019 to December 2021, 72 patients with chronic lateral ankle instability induced by IIII degree injury of anterior talofibular ligament in Dongguan Hospital of Traditional Chinese Medicine were selected. Arthroscopic ankle surgery was performed. They were randomly divided into two groups according to a prospective random number table, including 36 cases repaired with InternalBrace (InternalBrace group) and 36 cases repaired with suture anchors (suture anchor group). Intraoperative blood loss, operation time, “back to sport” time, the tilt angle of talus and the anterior displacement distance of talus in last follow-up, visual analogy scale score, American Orthopaedic Foot and Ankle Society Score (AOFAS score), Kofoed ankle function score, Japanese Society for Surgery of the Foot (JSSF) scale and Tegner score were compared between the two groups. Complications such as recurrence, rejection and wound infection of lateral ankle instability were counted.  
RESULTS AND CONCLUSION: (1) 72 patients were followed up for 6 to 18 months. (2) The AOFAS score, Kofoed ankle function score, JSSF scale and Tegner score, the tilt angle of talus and the anterior displacement distance of talus in last follow-up of InternalBrace group were significantly better than those of the suture anchor group (P < 0.05), and the excellent rates both were 100%. (3) There were no complications such as recurrence of lateral ankle instability, rejection or wound infection in the two groups after surgery. (4) There was no significant difference in the intraoperative blood loss, operation time and visual analogy scale score between the two groups at the last follow-up (P > 0.05). (5) It is indicated that all-arthroscopic repair of anterior talofibular ligament with InternalBrace for chronic lateral ankle instability is beneficial for sufficient strength and ankle stability. Satisfactory ankle function recovery can lead to better outcomes and faster return to sports.
Key words: ankle arthroscopy, chronic lateral ankle instability, anterior talofibular ligament, suture anchors, InternalBrace