Outcomes of a Modified Arthroscopic-assisted Reconstruction Technique for Lateral Ankle Instability

Sánchez, Carlos A.; Briceño, Ignacio; Robledo, Jaime

doi:10.1055/s-0041-1741446

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Sumário

Original Article • Rev. bras. ortop. 57 (04) • Jul-Aug 2022 • https://doi.org/10.1055/s-0041-1741446 copy

Outcomes of a Modified Arthroscopic-assisted Reconstruction Technique for Lateral Ankle Instability

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study assesses the results of a minimally invasive surgical technique for acute and chronic ankle instability management.

Methods

The present case series study retrospectively evaluated 40 patients undergoing arthroscopic-assisted percutaneous ankle ligament reconstruction from 2013 to 2019.

Results

The present study included 17 males and 23 females with an average age of 38.3 years old. Postintervention follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores identified improvement of > 30 points in function and pain control. The most frequently occurring associated injuries were osteochondral (35%). No patient required reintervention or had infection during follow-up.

Conclusion

The technique in the present study is easy and achieves satisfactory results for function and pain control.

Level of Evidence IV.

Keywords
ankle joint; arthroscopy; joint instability; ligaments; articular; subtalar joint; tendons

	Overall (n= 40)
Year of initial surgery
2013	1 (2.5%)
2014	1 (2.5%)
2015	3 (7.5%)
2016	1 (2.5%)
2017	8 (20%)
2018	11 (27.5%)
2019	15 (37.5%)
Years after the initial surgery
Mean (SD)	2.33 (1.49)
Median (min, max)	2.0 (1.0- 7.0)
Age at the moment of surgery
Mean (SD)	38.3 (14.2)
Median (min, max)	38 (17-64)
Biological gender
Male	17 (42.5%)
Female	23 (57.5%)
Injury laterality
Right	22 (55%)
Left	18 (45%)
Associated injury
Osteochondral lesion	14 (35%)
Loose bodies	-
Impingement	5 (12.5%)
Other	4 (10%)
None	17 (42.5%)
Time from injury to surgery
Days	2 (5%)
Months	16 (40%)
Years	22 (55%)

	Before surgery (n= 40)	After surgery (n= 40)
Pain
None	1 (2.5%)	23 (57.5%)
Mild/occasional	4 (10%)	15 (37.5%)
Moderate/daily	25 (62.5%)	2 (5%)
Severe/almost always present	10 (25%)	-
Activity limitation, support requirements
No limitation/no support requirement	-	24 (60%)
No limitation of daily activities, limitations of recreational activities, no support	14 (35%)	14 (35%)
Limited daily and recreational activities, cane	23 (57.5%)	2 (5%)
Severe limitation of daily and recreational activities, walker, crutches, wheelchair, brace	3 (7.5%)	-
Gait abnormality
None, slight	27 (67.5%)	40 (100%)
Obvious	9 (22.5%)	-
Marked	4 (10%)	-
Sagittal motion (flexion plus extension)
Normal or mild restriction (≥ 30°)	12 (30%)	33 (82.5%)
Moderate restriction (15-29°)	24 (60%)	7 (17.5%)
Severe restriction (< 15°)	4 (10%)	-
Ankle - hindfoot stability (anteroposterior, varus - valgus)
Stable	-	40 (100%)
Definitely unstable	40 (100%)	-
AOFAS score
Mean (SD)	55.4 (14.4)	93.7 (6.71)
Median [min, max]	59 [23 - 85]	96 [74 - 100]

	Overall
	(n= 40)
Maximum walking distance (blocks)
> 6	40 (100%)
4 to 6	-
1 to 3	-
< 1	-
Walking surfaces
No difficulty on any surface	34 (85%)
Some difficulty on uneven terrain, stairs, inclines, ladders	6 (15%)
Severe difficulty on uneven terrain, stairs, inclines, ladders	-
Hindfoot motion (inversion plus eversion)
Normal or mild restriction (75-100%)	39 (97.5%)
Moderate restriction (25-74% of normal)	1 (2.5%)
Marked restriction (< 25% of normal)	-
Foot alignment
Good, plantigrade foot, ankle-hindfoot well aligned	40 (100%)
Fair, plantigrade foot, some ankle-hindfoot malalignment observed, no symptoms	-
Poor, nonplantigrade foot, severe malalignment, symptoms	-

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Carlos Alberto Sánchez Correa, MD, Orthopedics and Traumatology, Pontificia Universidad Javeriana, Carrera 18 #88-10, Apto. 501, Bogotá, D.C., Colombia (e-mail: carsan.ortoinv@gmail.com).