Lateral ankle sprains are common. Occasionally, however, conservative treatment fails. In those cases chronic instability can develop and the best alternative for the patient becomes stabilization surgery. The surgeon is faced with several surgical procedures and, as described in the literature, those that most closely reproduce normal ankle lateral ligament anatomy and kinematics have been shown to have the best outcomes.
Study Supports All-Inside Arthroscopic Surgery Repairs for Unstable Ankles
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Historically, arthroscopy has been used by surgeons as an adjunct to open ligament surgery where its value is primarily as a tool to improve diagnosis and management of any associated intra-articular lesions. In cases like this, surgeons perform stabilization using an open approach since standard anterior ankle arthroscopy provides only a partial visualization of the anterior talofibular ligament from above, and the calcaneofibular ligament attachments cannot be seen at all.
But, over the past few years, several surgeons have tried an all-inside arthroscopic approach. This study tested the all-inside arthroscopic procedure to treat ankles that were unstable as a result of repetitive sprains. They found that using the all-inside approach allowed all 21 of the study participants to return to playing sports. Furthermore, there were few complications at the two-and-a-half-year follow-up. The study and its results were reported by investigator Elena Vacas at the Barcelona meeting of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) Congress in May.
The patients, who had a mean age of 30 years, had all-inside arthroscopic anatomical repair of their anterior talotibial ligaments. According to writer Susan Rapp, there were 15 men in the cohort and 12 right and 9 left ankles. All participants had experienced continued problems for a maximum of three months after a sprain. They were operated on between May 2012 and January 2013.
Vacas explained, “All-inside arthroscopic anatomical repair technique has excellent clinical and functional outcomes, and patients returned to their previous sport activity in a short period of time with a low percentage of complications. Arthroscopy allows us to treat associated injuries at the same surgical time with less soft tissue damage and excellent postoperative recovery.”
Healio.com’s Susan M. Rapp quoted Vacas as saying that the arthroscopic procedure used produces a stable ankle because it involves two tunnels. It also enables the surgeon to check and correct the quality of the ligament tissue intraoperatively.
Paper citation: Arroyo Hernandez M, et al. Paper #FP07-6193. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 4-7, 2016; Barcelona.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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