Comparative study of arthroscopic anterior talofibular ligament repair for chronic lateral ankle instability with or without os subfibulare
Author(s):
Takahashi K. (Japan)
,
Takahashi K. (Japan)
Affiliations:
Takahashi T.
,
Takahashi T.
Affiliations:
Fukuda H.
,
Fukuda H.
Affiliations:
Asai S.
,
Asai S.
Affiliations:
Tsuchiya A.
Tsuchiya A.
Affiliations:
ESSKA Academy. Takahashi K. 05/09/18; 209236; P01-1239 Topic: Arthroscopic Surgery
Kenji Takahashi
Kenji Takahashi
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Abstract
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Objectives: To investigate the clinical results after arthroscopic anterior talofibular ligament(ATFL) repair for chronic lateral ankle instability(CLAI) and examine the difference between the cases accompanied with and without os subfibulare.

Methods: We identified 27 patients (28 ankles) with CLAI, who were followed by arthroscopic ATFL repair using the mattress stitches, the suture anchors or the knotless anchors, either, at least for more than 6 months. There were 10 males and 18 females with mean age of 23.6 years (12 to 59 years). Mean follow-up periods after operation was 13.8 months (6 to 25 months). There were 13 ankles accompanied with os subfibulare (group O) and 15 ankles without ossicle (group N). We investigated AOFAS score and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) for clinical resullts, and measured the talar tilt angle (TTA) and the anterior talar displacement (ATD) on the stress X-ray images before surgery and at the postoperative final examination for the instability index. We compared these data between the both groups. In addition, the group O is divided into 2 groups depend on the size of ossicle ( the maximum length is ≥ 1 cm: group Ob n=4, < 1cm: group Os n=9), and we compared the pre- and the post- operative instability index among the group Ob, Os and N. These data was analyzed using paired-t test, Student t-test and one way-ANOVA (p<0.05).

Results: No patient in either group complained the ankle instability at follow-up postoperatively. The AOFAS score and the subscales of SAFE-Q, which are "pain & pain related", "social functioning", "shoe-related" and "sports activity", improved significantly in both groups postoperatively (P<.05), but there was no significant difference between both groups at the final follow-up. On the stress radiography, mean TTA in both groups and mean ATD in group N were significantly decreased at final follow-up (group O: 8.4±4.2°to 5.9±3.6°p<.01, group N: 10.3±4.2° to 6.8±2.7°p<.05, 6.8±2.7mm to 4.8±1.3mm p<.01). Between the both groups, there were no significant differences at the final follow-up in TTA and ATD. Among the 3 groups, however, the postoperative TTA in the group Ob was significantly smaller than in the other 2 groups (group Ob 2.7±1.0°vs group Os 7.3±1.5°p=0.032, vs group N 6.8±2.7°p=0.044).

Conclusions: In our case series study after arthroscopic ATFL repair, the clinical results and the lateral instability at final follow-up were equivalent in both groups. What should be noted is that the group Ob was most stable in postoperative instability among 3 groups. In the case with big ossicle, the status of the ligament may be better than in another groups. Therefore, if arthroscopic resection of the ossicle is performed without damage, the better results can be expected in the case of big ossicle.

Keywords:
Arthroscopy, Anterior Talofibular Ligament Repair, Os Subfibulare
Objectives: To investigate the clinical results after arthroscopic anterior talofibular ligament(ATFL) repair for chronic lateral ankle instability(CLAI) and examine the difference between the cases accompanied with and without os subfibulare.

Methods: We identified 27 patients (28 ankles) with CLAI, who were followed by arthroscopic ATFL repair using the mattress stitches, the suture anchors or the knotless anchors, either, at least for more than 6 months. There were 10 males and 18 females with mean age of 23.6 years (12 to 59 years). Mean follow-up periods after operation was 13.8 months (6 to 25 months). There were 13 ankles accompanied with os subfibulare (group O) and 15 ankles without ossicle (group N). We investigated AOFAS score and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) for clinical resullts, and measured the talar tilt angle (TTA) and the anterior talar displacement (ATD) on the stress X-ray images before surgery and at the postoperative final examination for the instability index. We compared these data between the both groups. In addition, the group O is divided into 2 groups depend on the size of ossicle ( the maximum length is ≥ 1 cm: group Ob n=4, < 1cm: group Os n=9), and we compared the pre- and the post- operative instability index among the group Ob, Os and N. These data was analyzed using paired-t test, Student t-test and one way-ANOVA (p<0.05).

Results: No patient in either group complained the ankle instability at follow-up postoperatively. The AOFAS score and the subscales of SAFE-Q, which are "pain & pain related", "social functioning", "shoe-related" and "sports activity", improved significantly in both groups postoperatively (P<.05), but there was no significant difference between both groups at the final follow-up. On the stress radiography, mean TTA in both groups and mean ATD in group N were significantly decreased at final follow-up (group O: 8.4±4.2°to 5.9±3.6°p<.01, group N: 10.3±4.2° to 6.8±2.7°p<.05, 6.8±2.7mm to 4.8±1.3mm p<.01). Between the both groups, there were no significant differences at the final follow-up in TTA and ATD. Among the 3 groups, however, the postoperative TTA in the group Ob was significantly smaller than in the other 2 groups (group Ob 2.7±1.0°vs group Os 7.3±1.5°p=0.032, vs group N 6.8±2.7°p=0.044).

Conclusions: In our case series study after arthroscopic ATFL repair, the clinical results and the lateral instability at final follow-up were equivalent in both groups. What should be noted is that the group Ob was most stable in postoperative instability among 3 groups. In the case with big ossicle, the status of the ligament may be better than in another groups. Therefore, if arthroscopic resection of the ossicle is performed without damage, the better results can be expected in the case of big ossicle.

Keywords:
Arthroscopy, Anterior Talofibular Ligament Repair, Os Subfibulare
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