Arthroscopic-Assisted Versus All-Arthroscopic Ankle Stabilization Technique

Abstract

Background: Both the percutaneous technique with arthroscopic assistance, also known as arthroscopic Broström (AB), and the arthroscopic all-inside ligament repair (AI) are widely used to treat chronic lateral ankle instability. The aim of this study was to compare the clinical outcomes of these 2 arthroscopic stabilizing techniques. Methods: Thirty-nine consecutive patients were arthroscopically treated for chronic ankle instability by 2 different surgeons. The AB group comprised 20 patients with a mean age of 30.2 (range, 18-42) years and a mean follow-up of 19.6 (range, 12-28) months. The AI group comprised 19 patients with a mean age of 30.9 (range, 18-46) years and mean follow-up of 20.7 (range, 13-32) months. Functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog pain scale (VAS) were assessed pre- and postoperatively. Range of motion (ROM) and complications were recorded. Results: In both groups the AOFAS and VAS scores significantly improved compared with preoperative values ( P < .001) with no difference ( P > .1) between groups. In the AB group the mean AOFAS score improved from 67 (range, 44-87) to 92 (range, 76-100) and the mean VAS score from 6.4 (range, 3-10) to 1.2 (range, 0-3). In the AI group the mean AOFAS score changed from 60 (range, 32-87) to 93 (range, 76-100) and the mean VAS score from 6.1 (range, 4-10) to 0.8 (range, 0-3). At the final follow-up 8 complications (40%) were recorded in the AB group. In the AI group 1 complication (5.3%) was observed ( P < .05). Conclusion: Both the AB and AI techniques are suitable surgical options to treat chronic ankle instability providing excellent clinical results. However, the AB had a higher overall complication rate than the AI group, particularly involving a painful restriction of ankle plantarflexion and neuritis of the superficial peroneal nerve. Level of Evidence: Level III, retrospective comparative study.

Does arthroscopic repair show superiority over open repair of lateral ankle ligament for chronic lateral ankle instability: a systematic review and meta-analysis

“…The arthroscopic techniques include arthroscopic-assisted techniques, allarthroscopic techniques, and all-inside techniques [45]. Among those, suture knots of all-inside techniques are tied within the joint, while sutures are tied extracapsularly in the other two techniques, which increase the risk of entrapment of surrounding anatomical structures and increase the complicate rate [46]. In order to reduce the incidence of nerve injury during arthroscopic repair, Acevedo et al identified a "safe zone," with a mean length of 51 mm between the intermediate branch of the superficial peroneal nerve (SPN) and sural nerve, and found that a safe distance of 20 mm (range, 8-36 mm) was maintained from the most medial suture to the intermediate branch of the SPN [47].…”

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

“…The close relationship of the IER with surrounding nerves is still a critical point to consider when performing a modified Broström-Gould procedure [ 29 ]. According to Guelfi et al’s study, compared with arthroscopic all-inside repair techniques, a higher rate of neuritis was encountered in the arthroscopic-assisted technique [ 30 ]. So, the key point for avoiding nerve injuries is performing all procedures under direct visualization.…”

Arthro-Broström with Endoscopic Retinaculum Augmentation using All-inside Lasso-loop Stitch Techniques

“…The close relationship of the IER with surrounding nerves is still a critical point to consider when performing a modi ed Broström-Gould procedure [29]. According to Guel et al's study, compared with arthroscopic all-inside repair techniques, a higher rate of neuritis was encountered in the arthroscopic-assisted technique [30]. So, the key point for avoiding nerve injuries is performing all procedures under direct visualization.…”