2015 ISAKOS Biennial Congress ePoster #120

All-Inside Arthroscopic Repair of the Anterior Talo - Fibular Ligament for Lateral Ankle Instability

Andrzej Mioduszewski, MD, PhD, Warsaw POLAND
Robert Swierczynski, MD, PhD, Warsaw POLAND
Mikolaj Wrobel, MD, Warsaw POLAND
Juliusz Sroczynski, MD, Warszawa, mazowieckie POLAND
Grzegorz Klos, MD, Warsaw POLAND
Mateusz Zelik, MD, Warsaw POLAND

Ortopedika - Centrum chirurgii Specjalistycznej, Warsaw, POLAND

FDA Status Not Applicable

Summary: We present serie of cases of arthroscopic repair of the torn ATFL. We developed a method of releasing scar of the ATFL and its reinsertion to Fibula or Talus, depending of tear pattern with suture anchor.



First attempts of arthroscopic reconstruction of ATFL were performed in the eighties but due to technology deficiencies it didn’t gain popularity until recent years. Recently, arthroscopic-assisted techniques have been described to treat lateral ankle instability with promising results. The aim of this paper is to describe our method of the ATFL repair and its results in our patients with acute or chronic Ankle instability.
Between March 2011 and September 2014 we performed 13 arthroscopic ATFL reconstructions of the ankle. There were 2 female and 10 male (1 operated bilaterally). Mean age was 31,3. Mean follow-up - 18, 8 months. Before surgery efficiency of the ATFL and CFL were evaluated on ultrasound examination. Also AOFAS score was assessed prior to surgery.
During surgery ATFL scar was stabilized with 3,5 mm suture anchor to lateral ankle in 9 cases, to Talus in 3 cases and in both insertion points in one case during standard arthroscopy of the anterior compartment of the ankle joint. Additional approach was created over the ATFL scar in all cases. After surgery all patients were subjected to the same physical therapy protocol. Three months after surgery ultrasonographic control was performed. It was repeated altogether with AOFAS score immediately prior to analysis.
In all cases ligament healing was observed in ultrasonographic evaluation. In one case the ligament scar was slightly elongated with preserved subjective joint stability. In one case a neuroma from cutaneous branch of the peroneal nerve in anterior-lateral portal occurred. In all cases there was improvement in CFL tension. The mean AOFAS score was 87,8 postoperatively ( 75 to 100).
We consider that arthroscopic repair of the ATFL is valuable method of treatment in selected cases and offers a good alternative to open reconstruction procedures.