Summary

Twenty-seven athletes underwent all-inside arthroscopic lateral ankle ligament repair with accelerated rehabilitation and returned to sports 38.6 ± 8.8 days after surgery, which means that all-inside arthroscopic lateral ankle ligament repair with accelerated rehabilitation achieved earlier return to sports compared to the previously reported open procedures.

Abstract

Backgrounds: Recently, arthroscopic lateral ankle ligament repair techniques have become increasingly popular and have been expected to achieve better clinical results compared to open procedures. However, several comparative studies investigating arthroscopic versus open lateral ankle ligament repair techniques have reported similar clinical results at a minimum follow-up of one year or two years and failed to show superiority of arthroscopic surgery. Though these clinical results at a final follow-up is important, time to return to sports after surgery is another major concern among athletes. According to the five reports which clearly mentioned the time to return to sports after open reconstruction surgery for lateral ankle instability, mean time to return to sports has been reported to be 9.5 to 17.1 weeks (range; 7 to 22 weeks). On the other hand, the information regarding the time to return to sports after arthroscopic techniques is limited. Considering the literature which reported the effects of accelerated rehabilitation on early return to activity, it was hypothesized that combination of less invasive all-inside arthroscopic lateral ankle ligament repair and accelerated rehabilitation would achieve earlier return to sports after surgery compared to the previously reported open procedures. The purpose of the present study was to investigate the time to return to training and sports after all-inside arthroscopic lateral ankle ligament repair and compare the results with the previously reported results of open procedures.

Methods

Between July 2017 and June 2018, a consecutive series of 95 patients underwent all-inside arthroscopic lateral ankle ligament repair in our hospital. Of 95, 73 had isolated all-inside arthroscopic lateral ankle ligament repair without any procedures for additional injuries such as osteochondral lesions, deltoid ligament injuries and so on. Among them, patients who were athletes and underwent post-operative rehabilitation in our hospital were included. Non-athletes or athletes who underwent post-operative rehabilitation in other hospitals were excluded. With the post-operative rehabilitation protocol in our hospital, full weight-bearing was allowed from the first postoperative day and proprioceptive training and physical training were performed to achieve jogging after two post-operative weeks, sprinting after four post-operative weeks. Data of the time required to start independent gait, jogging, sprinting and the time to return to sports were analyzed. Reinjury and recurrence of the instability were also recorded.

Results

Twenty-seven athletes (7 males, 20 females, mean age 22.2 ± 14.6) were included. Of these, six patients underwent simultaneous bilateral arthroscopic all-inside arthroscopic lateral ankle ligament repair. Gould-augmentation was added for 19 foot in 16 patients. The time to start independent gait, jogging, sprinting and the time to return to sports after surgery were 1.4 ± 0.9, 16.0 ± 3.3, 31.7 ± 4.6 and 38.6 ± 8.8 (mean ± SD) days respectively. No re-injury or recurrence of instability was reported at the mean follow-up period of 6 months (range; 2 to 12 months).

Conclusion

This study demonstrates that all-inside arthroscopic lateral ankle ligament repair with accelerated rehabilitation achieved earlier return to sports compared to the previously reported open procedures.