Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair

Abstract

Purpose The relationship between ligament remnant quality and postoperative outcomes after arthroscopic lateral ankle ligament repair for chronic lateral ankle instability is controversial. This study aimed to determine whether the signal intensity of the anterior taloibular ligament on preoperative magnetic resonance imaging and ligament remnant quality identiied on arthroscopy are associated with recurrent ankle instability after arthroscopic lateral ankle ligament repair. Methods A total of 68 ankles from 67 patients with chronic lateral ankle instability who underwent arthroscopic lateral ankle ligament repair were retrospectively studied. The signal intensity of the anterior taloibular ligament was evaluated using T2-weighted magnetic resonance imaging. Arthroscopy was used to evaluate the thickness and mechanical resistance of the anterior taloibular ligament by hook palpation and to classify ankles into two groups: the present anterior taloibular ligament group with adequate mechanical resistance and the absent anterior taloibular ligament group with no mechanical resistance. The outcomes included recurrent ankle instability (respraining of the operated ankle after surgery) and Self-Administered Foot Evaluation Questionnaire scores. Results Thirteen ankles were diagnosed with recurrent ankle instability. Patients with a high anterior taloibular ligament T2 signal intensity experienced more recurrent ankle instability than those with a low intensity. As determined via arthroscopy, the absent anterior taloibular ligament group had a higher rate of recurrent ankle instability than the present anterior taloibular ligament group. There were no signiicant diferences in Self-Administered Foot Evaluation Questionnaire scores between patients with high and low anterior taloibular ligament T2 signal intensity, as well as between absent and present anterior taloibular ligament groups based on arthroscopy. Conclusion Poor quality of the anterior taloibular ligament remnant could result in recurrent ankle instability after arthroscopic lateral ankle ligament repair. Therefore, when treating chronic lateral ankle instability, surgeons should consider ligament quality. Level of Evidence IV.

Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair

“…Poor quality of ATFL remnant could result in significantly higher recurrent instability because the ATFL has been replaced by scar tissue. 43 In the current study, the ATFL remnant quality in the recurrence group was often poorer than that in the nonrecurrence group. The quality of the remnant can be predicted by thin-slice MRI signal intensity preoperatively.…”

“…23 It is difficult to define the recurrence of the instability after surgery. Yoshimoto et al 43,44 defined recurrent instability as ankle resprain after surgery. In this study, recurrent instability was defined as a postoperative TTA of ≥6 degrees because it is reported that a normal TTA was <5 degrees.…”

Advancement of Periosteal and Capsular Complexes With or Without Augmentation Using a Free Graft From Lower Extensor Retinaculum: A Comparative Study With Propensity Score Matching

“…25,28,41 Unlike the ATFL, the CFL is an extracapsular ligament that is difficult to completely repair arthroscopically. 27,45 The combined injury of ATFL and CFL produces more severe damage than a single injury, 27 and an additional arthroscopic augmentation did not improve the outcome. 45 Because of the difficulty in arthroscopic repair of the CFL, many surgeons who attempt complete arthroscopic surgery alone are likely to perform reconstruction using a tendon graft for all ankles, except in cases of isolated ATFL injury.…”

“…27,45 The combined injury of ATFL and CFL produces more severe damage than a single injury, 27 and an additional arthroscopic augmentation did not improve the outcome. 45 Because of the difficulty in arthroscopic repair of the CFL, many surgeons who attempt complete arthroscopic surgery alone are likely to perform reconstruction using a tendon graft for all ankles, except in cases of isolated ATFL injury. In our opinion, this may be overtreatment for combined injuries of the ATFL and CFL with remnants.…”

“…5 However, instability may recur depending on the remnant quality. 27,45 When the ligament has lost tension but still has a residual ligament component (remnant), symptoms improve with suturing, and ligament tension is restored. The Broström-Gould technique is a modification of the Broström procedure for cases with poor-quality residual ligaments.…”