Arthro-Broström with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques

Abstract

Background There is still some controversy about the augmentation of the inferior extensor retinaculum after arthroscopic anterior talofibular ligament repair. The aim of this study was to evaluate the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques for chronic lateral ankle instability. Methods Thirty-four cases with grade-2 or grade-3 chronic anterior talofibular ligament lesions who underwent the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques were assessed retrospectively. A total of 30 cases (30 ankles) were followed up for a mean of 26.67 ± 4.19 months (range, 24—36 months). four cases were excluded due to insufficient medical records or loss of follow-up reports. The Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were evaluated before surgery and at the final follow-up time. Also, the results of stress fluoroscopic tests and complications were recorded. Results At the final follow-up, the average of the Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were 86.63 ± 6.69 (range, 77—100), 90.17 ± 4.64 (range, 85—100) and 0.53 ± 0.63 (range, 0—2), respectively. Moreover, the results of stress fluoroscopic tests were improved significantly after surgery. Mild keloid formation and/or knot irritation were observed in four cases. No wound infections, nerve injuries and recurrent instability were recorded. Also, no stiffness or arthritis of the subtalar joint was encountered. Conclusions The arthro-Broström procedure combined with endoscopic retinaculum augmentation using all-inside lasso-loop techniques is reliable and safe due to the advantage of direct endoscopic visualization.

Chronic lateral ankle instability using anterior tibiofibular ligament distal fascicle transfer augmentation repair: an anatomical, biomechanical, and histological study

“…Improved repair of the inferior extensor retinaculum provides initial protection and improved repair of the ATFL for the rotational function of the joint ( Dalmau-Pastor et al, 2018 ). In addition, inferior extensor retinaculum augmentation may be performed using the total inner gloving technique to avoid nerve injury ( Yang et al, 2022 ). In 2019, Vega et al ( Vega et al, 2020 ) performed total arthroscopic ATiFL-DF transfer enhancement using five fresh-frozen ankle joint specimens and reported that transfer via the anterior-lateral portal did not harm the superficial peroneal nerve.…”

Both arthroscopic one‐step Broström–Gould and Lasso‐loop stitch techniques achieved favourable clinical outcomes for chronic lateral ankle instability

“…Both the arthroscopic Lasso-loop stitch technique and arthroscopic Broström-Gould technique have been commonly used to treat CLAI patients, and multiple studies have reported satisfactory outcomes in terms of postoperative clinical and functional scoring [31,41]. Rigby et al reported 30 CLAI patients receiving the arthroscopic outside-in Broström-Gould technique, with the average postoperative VAS pain score decreasing from 8.2 to 1.5 and AOFAS score improving from 35.1 to 95.3 [29].…”

“…However, 20%-40% of patients are prone to progress to chronic lateral ankle instability (CLAI), leading to persistent pain, recurrent sprains and repeated episodes of the ankle giving way [37,38]. The modified Broström procedure has been widely accepted as the gold standard for operative treatment of CLAI [39], and various arthroscopic Broström surgeries have been published [4,6,9,17,24,28,41] demonstrating feasible clinical outcomes [6,17,38,44].…”

“…The most widely used arthroscopic lateral ankle stabilization techniques include the Lasso-loop stitch technique to grip the maximum possible amount of the ATFL remnant [28,42] and the arthroscopic outside-in technique incorporating ATFL repair and inferior extensor retinaculum (IER) reinforcement [1,15,40]. Although satisfactory results of the IER reinforcement have been reported [12,29,31,41], some argued that IER augmentation might restrict full plantar flexion and inversion of the ankle [12,27] and increase the risk of neurogenic problems because of its proximity to surrounding nerves [7]. To date, few studies have compared the clinical efficacy, return to sports and complications between the two techniques [12].…”

Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament

“…Line anchors enhance ATFL repair and lays a solid foundation for postoperative healing and early high-intensity rehabilitation exercise programs. Arthroscopic arthro-Broström supported band enhancement using the all-medial lasso loop suture technique avoids nerve injury and does not interfere with subtalar joint stability[ 67 ]. With the rapid emergence of new technology, in the future, we may need to explore and utilize the advantages of various surgical techniques and treatment management tools[ 68 ].…”