A four-step approach improves long-term functional outcomes in patients suffering from chronic ankle instability: a retrospective study with a follow-up of 7–16 years

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 29; no. 5; pp. 1612 - 1616
• Main Authors: Ventura, Alberto, Borgo, Enrico, Terzaghi, Clara, Macchi, Vittorio, Legnani, Claudio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2021; Springer Nature B.V
• Subjects: Adult; Ankle; Ankle Injuries - physiopathology; Ankle Injuries - surgery; Arthroscopy - methods; Complications; Debridement; Female; Follow-Up Studies; Humans; Immobilization; Instability; Joint Instability - physiopathology; Joint Instability - surgery; Lesions; Ligaments, Articular - injuries; Ligaments, Articular - physiopathology; Ligaments, Articular - surgery; Lysholm Knee Score; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Patients; Range of Motion, Articular; Retrospective Studies; Shrinkage; Sports Medicine; Stability; Stability analysis; Statistical analysis; Surgery; Synovectomy; Ankle; Thermal capsular shrinkage; Ankle arthroscopy; Chronic ankle instability; long-term outcomes
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-020-06368-9

Purpose The aim of the present study was to assess the long-term outcomes of the treatment of chronic ankle instability (CAI) with a four-step protocol. Methods Fifty-four patients with isolated anterior talo-fibular ligament (ATFL) lesion suffering from CAI who underwent surgical treatment between 2000 and 2009 were assessed. All the patients underwent a four-step protocol including synovectomy, debridement of ATFL lesion borders, capsular shrinkage, and 21-day immobilization and nonweightbearing. Median age at surgery was 31.6 years (18–48). Patients were examined preoperatively and at follow-up. Clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system, Karlsson–Peterson score, Tegner activity level, and objective examination comprehending range of motion (ROM) and manual laxity tests. Results AOFAS (preoperative, 64.8; postoperative, 92.4; p  < 0.001) and Karlsson-Peterson score (preoperative, 62.5; postoperative, 88.8; p  < 0.001) significantly improved after a median 11 years follow-up (7–16 years). Similarly median Tegner activity level significantly increased at follow-up compared to pre-operatory status (6.0 and 4.0 respectively, p  < 0.001). Objective examination documented a statistically significant improvement in terms of ankle stability compared to pre-operative manual laxity tests, with negative anterior drawer test observed in 48 (88.9%) patients ( p  < 0.001). Sagittal ROM was full in 50 patients (92%). Nine patients had subsequent ankle sprains (15.6%), two patients required further surgery, while seven were treated conservatively. No major complications were reported. Conclusion Satisfying subjective and objective clinical outcomes in selected patients with isolated ATFL lesion suffering from CAI were reported with a treatment protocol including arthroscopic synovectomy, debridement of ATFL remnants, capsular shrinkage, and immobilization. These findings are of clinical relevance because they provide a suitable minimally invasive method for the treatment of mild to moderate ankle instability. Level of evidence Level IV