High body mass index is not a contraindication for an arthroscopic ligament repair with biological augmentation in case of chronic ankle instability

Abstract

Purpose Obesity remains frequently mentioned as a contraindication for lateral ankle ligament repair. The aim of the study was to compare the clinical results of an arthroscopic lateral ligament repair with biological augmentation between patients with a body mass index (BMI) of more than 30 and less than 30. Methods Sixty-nine patients with an isolated lateral ankle instability were treated with an arthroscopic anterior taloibular ligament (ATFL) repair with biological augmentation using the inferior extensor retinaculum (IER). Patients were divided into two groups according to their BMI: ≥ 30 (Group A; n = 26) and < 30 (Group B; n = 43). Patients were pre-and postoperatively evaluated, with a minimum of 2 years follow-up, and using the Karlsson Score. Characteristics of the patients, complications, ankle instability symptoms recurrence, and satisfaction score were recorded. Results In group A, the median Karlsson Score increased from 43.5 (Range 22-72) to 85 (Range 37-100) at follow-up. Complications were observed in seven patients (27%). Nineteen patients (73%) reported that they were "very satisied". One patient (4%) described persistent ankle instability symptoms. In group B, the median Karlsson Score increased from 65 (Range 42-80) to 95 (Range 50-100) at follow-up. Complications were observed in four patients (9%). Thirty-three patients (77%) reported that they were "very satisied". Two patients (5%) described persistent ankle instability symptoms. Pre-operative and at last follow-up Karlsson Score, results were signiicantly diferent between the two groups. There was no signiicant statistical diference in favour of satisfaction score, complications and recurrence of ankle instability between the two groups. Conclusion ATFL repair with biological augmentation using IER gives excellent results for patients with BMI ≥ 30. Compared to patients with BMI < 30, they present a slightly lower preoperative and postoperative Karlsson score, however, with a similar satisfaction rate, but are at higher risk of transient supericial peroneal nerve dysesthesia. Level of evidence Level III.

Effectiveness of High-Velocity Low-Amplitude Manipulation in the Treatment of Ankle Joint Dysfunction: A Comprehensive Review

“…In young athletes, like the baseball players in one of the studies, significant improvements in ankle range of motion and pain reduction were observed post-manipulation (Fryer, Mudge & McLaughlin, 2002). This finding was echoed in the study focusing on individuals with chronic ankle instability, where improved dorsiflexion was noted (Marrón-Gómez, Rodríguez-Fernández & Martín-Urrialde, 2015;Guiraud, et al, 2023). Particularly notable, is the suggestion from the study involving elite female handball players that manipulation might not only aid in rehabilitation but could also play a role in enhancing athletic performance, as evidenced by improved vertical jump heights (Hedlund et al, 2014).…”

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

“…In the present study, all surgical operations were performed in the safe zone [11], with only two patients (4.8%) in Group A complaining of knot irritation and one patient (3.1%) in Group B complaining of incision numbness at follow-up. To avoid SPN injury, the SPN was marked in case of its visibility [13]. Furthermore, the AM portal was established first, which was far from the nerve, and the AL and the acAL portals were made with transillumination.…”