Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair

Abstract

Background: Hindfoot varus deformity is a known risk factor for chronic lateral ankle instability (CLAI). The impact of this deformity on clinical results following arthroscopic lateral ankle ligament repair (ALLR) for CLAI has not been studied. Methods: Sixty-three ankles from 62 patients who received ALLR for CLAI were retrospectively examined. Preoperative plain radiographs were used to measure tibial articular surface (TAS) angles, and long axial hindfoot alignment radiographs were used to measure tibiocalcaneal angles (TCAs) pre- and postoperatively. Results included ratings on the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and recurrent ankle instability (respraining of the operated ankle following surgery). Results: Recurrent ankle instability, defined as incidence of any new ankle sprain after surgery reported in the follow-up period, occurred in 13 ankles. The TAS angles of these patients were significantly low, and their preoperative TCA was significantly high. Multivariate analysis showed that preoperative TCA was an independent risk factor for recurrent ankle instability. The threshold values for preoperative TCA for recurrent instability were determined via the receiver operating characteristic curve analysis to be 3.4 degrees. Patients were assigned to a low- or high-TCA group based on the reported average TCA (2.7 degrees) of healthy patients. In the high-TCA group, recurrent instability was significantly more frequent, and the scores on the pain subscale of the postoperative SAFE-Q were significantly lower. Conclusion: Hindfoot varus alignment was associated with pooreroutcomes after ALLR. Level of Evidence: Level III, retrospective comparative study.

A Smaller Tibiotalar Sector Is a Risk Factor for Recurrent Anterolateral Ankle Instability after a Modified Broström-Gould Procedure

“…However, other studies showed no correlation between female sex and recurrent ankle instability. 34,52,55 This study has several limitations. First, because of the retrospective design, the study lacks preoperative Karlsson scores.…”

“…4,5,35,40 However, recurrent ankle instability after primary ligament repair has been reported in 18% to 28% of the patients. 29,30,[53][54][55] Potential clinical risk factors for recurrent ankle instability after lateral ligament repair are generalized ligamentous laxity and poor quality of the anterior talofibular ligament remnant, which also lead to poorer clinical outcomes. 34,52,53 Several morphologic risk factors of the ankle joint have been related to CAI such as a hindfoot varus, 6,28,43 a varus tilt of the tibial plafond, 44 a larger talar radius and talar height, and a smaller tibiotalar sector.…”

“…12 However, little is known if these factors also play a role in recurrent ankle instability after lateral ligament repair. 54,55 The objective of this study was to investigate the potential association between an unstable morphologic configuration of the ankle joint and the occurrence of recurrent instability and the influence of these morphologic factors on the clinical outcome after a modified Broström-Gould procedure for CAI. We hypothesized that a smaller tibiotalar sector, a varus tilt of the tibial plafond, a larger talar radius, and a higher talus, a smaller talar width, and a smaller ankle mortise angle are risk factors for recurrent ankle instability and are associated with a poorer clinical outcome.…”

“…4 , 5 , 35 , 40 However, recurrent ankle instability after primary ligament repair has been reported in 18% to 28% of the patients. 29 , 30 , 53 - 55 …”

“… 12 However, little is known if these factors also play a role in recurrent ankle instability after lateral ligament repair. 54 , 55 …”