J Korean Foot Ankle Soc.  2021 Mar;25(1):25-31. 10.14193/jkfas.2021.25.1.25.

Arthroscopic Procedure in the Treatment of Chronic Lateral Ankle Instability

Affiliations
  • 1Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea

Abstract

The open Broström procedure is considered the surgery of choice for treating chronic lateral ankle instability. The role of arthroscopy has gained popularity in the surgical treatment of chronic lateral ankle instability, partly for the ability to manage the intra-articular pathology combined with ankle instability. Arthroscopic techniques can be divided broadly into the arthroscopic-assisted Broström technique and arthroscopic all-inside ligament repair. The clinical results of these arthroscopic techniques are similar to open procedures. The arthroscopic technique may be an excellent alternative to the open Broström procedure in treating chronic lateral ankle instability when applying the appropriate indications.

Keyword

Ankle lateral ligament; Joint instability; Arthroscopy; Surgical procedures

Figure

  • Figure. 1 (A) Debride the synovial tissue with a shaver and visualize the remnant of anterior talofibular ligament. (B, C) Insert a suture lasso through the anterolateral portal to wrap the ligament from the lateral to the medial direction. Push the nitinol loop into the suture lasso and pull it out from the portal. (D) Remove the suture lasso from the anterolateral portal. (E) Replace the nitinol loop to a suture. Make a sliding knot on the ligament with the suture. (F) Drilling is performed on the fibular side origin of the anterior talofibular ligament before inserting the suture anchor. The drilling direction is tilted 45 degrees from the axis of fibula and parallel to the lateral gutter. (G) A knotless suture anchor is loaded with the suture arm which is tied on the anterior talofibular ligament and is inserted in the previously drilled hole with tension. (H) The anterior talofibular ligament is repaired on its origin.


Reference

1. Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, et al. 2018; Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 52:956. doi: 10.1136/bjsports-2017-098106. DOI: 10.1136/bjsports-2017-098106. PMID: 29514819.
Article
2. Cooke MW, Marsh JL, Clark M, Nakash R, Jarvis RM, Hutton JL, et al. 2009; Treatment of severe ankle sprain: a pragmatic randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of three types of mechanical ankle support with tubular bandage. The CAST trial. Health Technol Assess. 13:iiiix–x. 1–121. doi: 10.3310/hta13130. DOI: 10.3310/hta13130. PMID: 19232157.
Article
3. Brison RJ, Day AG, Pelland L, Pickett W, Johnson AP, Aiken A, et al. 2016; Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial. BMJ. 355:i5650. doi: 10.1136/bmj.i5650. DOI: 10.1136/bmj.i5650. PMID: 27852621. PMCID: PMC5112179.
Article
4. Ortega-Avila AB, Cervera-Garvi P, Marchena-Rodriguez A, Chicharro-Luna E, Nester CJ, Starbuck C, et al. 2020; Conservative treatment for acute ankle sprain: a systematic review. J Clin Med. 9:3128. doi: 10.3390/jcm9103128. DOI: 10.3390/jcm9103128. PMID: 32992655. PMCID: PMC7599579.
Article
5. O'Loughlin PF, Murawski CD, Egan C, Kennedy JG. 2009; Ankle instability in sports. Phys Sportsmed. 37:93–103. doi: 10.3810/psm.2009.06.1715. DOI: 10.3810/psm.2009.06.1715. PMID: 20048515.
6. Hubbard TJ. 2008; Ligament laxity following inversion injury with and without chronic ankle instability. Foot Ankle Int. 29:305–11. doi: 10.3113/FAI.2008.0305. DOI: 10.3113/FAI.2008.0305. PMID: 18348827.
Article
7. Hawkins RB. 1987; Arthroscopic stapling repair for chronic lateral instability. Clin Podiatr Med Surg. 4:875–83. PMID: 2960443.
8. Corte-Real NM, Moreira RM. 2009; Arthroscopic repair of chronic lateral ankle instability. Foot Ankle Int. 30:213–7. doi: 10.3113/FAI.2009.0213. DOI: 10.3113/FAI.2009.0213. PMID: 19321097.
9. Acevedo JI, Mangone PG. 2011; Arthroscopic lateral ankle ligament reconstruction. Tech Foot Ankle Surg. 10:111–6. doi: 10.1097/BTF.0b013e318229bdb8. DOI: 10.1097/BTF.0b013e318229bdb8.
Article
10. Vega J, Golanó P, Pellegrino A, Rabat E, Peña F. 2013; All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique. Foot Ankle Int. 34:1701–9. doi: 10.1177/1071100713502322. DOI: 10.1177/1071100713502322. PMID: 23978706.
Article
11. Ajis A, Maffulli N. 2006; Conservative management of chronic ankle instability. Foot Ankle Clin. 11:531–7. doi: 10.1016/j.fcl.2006.07.004. DOI: 10.1016/j.fcl.2006.07.004. PMID: 16971246.
Article
12. Maffulli N, Ferran NA. 2008; Management of acute and chronic ankle instability. J Am Acad Orthop Surg. 16:608–15. doi: 10.5435/00124635-200810000-00006. DOI: 10.5435/00124635-200810000-00006. PMID: 18832604.
Article
13. Drez D Jr, Young JC, Waldman D, Shackleton R, Parker W. 1982; Nonoperative treatment of double lateral ligament tears of the ankle. Am J Sports Med. 10:197–200. doi: 10.1177/036354658201000401. DOI: 10.1177/036354658201000401. PMID: 7125039.
Article
14. Smith RW, Reischl SF. 1986; Treatment of ankle sprains in young athletes. Am J Sports Med. 14:465–71. doi: 10.1177/036354658601400606. DOI: 10.1177/036354658601400606. PMID: 3099587.
Article
15. Willems T, Witvrouw E, Verstuyft J, Vaes P, De Clercq D. 2002; Proprioception and muscle strength in subjects with a history of ankle sprains and chronic instability. J Athl Train. 37:487–93. PMID: 12937572. PMCID: PMC164382.
16. Hupperets MD, Verhagen EA, van Mechelen W. 2009; Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 339:b2684. doi: 10.1136/bmj.b2684. DOI: 10.1136/bmj.b2684. PMID: 19589822. PMCID: PMC2714677.
Article
17. Hale SA, Hertel J, Olmsted-Kramer LC. 2007; The effect of a 4-week comprehensive rehabilitation program on postural control and lower extremity function in individuals with chronic ankle instability. J Orthop Sports Phys Ther. 37:303–11. doi: 10.2519/jospt.2007.2322. DOI: 10.2519/jospt.2007.2322. PMID: 17612356.
Article
18. McKeon PO, Ingersoll CD, Kerrigan DC, Saliba E, Bennett BC, Hertel J. 2008; Balance training improves function and postural control in those with chronic ankle instability. Med Sci Sports Exerc. 40:1810–9. doi: 10.1249/MSS.0b013e31817e0f92. DOI: 10.1249/MSS.0b013e31817e0f92. PMID: 18799992.
Article
19. Richie DH Jr. 2001; Functional instability of the ankle and the role of neuromuscular control: a comprehensive review. J Foot Ankle Surg. 40:240–51. doi: 10.1016/s1067-2516(01)80025-9. DOI: 10.1016/S1067-2516(01)80025-9. PMID: 11924686.
Article
20. Tully MA, Bleakley CM, O'Connor SR, McDonough SM. 2012; Functional management of ankle sprains: what volume and intensity of walking is undertaken in the first week postinjury. Br J Sports Med. 46:877–82. doi: 10.1136/bjsports-2011-090692. DOI: 10.1136/bjsports-2011-090692. PMID: 22267573.
Article
21. Valovich McLeod TC. 2008; The effectiveness of balance training programs on reducing the incidence of ankle sprains in adolescent athletes. J Sport Rehabil. 17:316–23. doi: 10.1123/jsr.17.3.316. DOI: 10.1123/jsr.17.3.316. PMID: 18708683.
22. Brostroem L. 1964; I. Anatomic lesions in recent sprains. Acta Chir Scand. 128:483–95. PMID: 14227127.
23. Broström L. 1966; VI. Surgical treatment of "chronic" ligament ruptures. Acta Chir Scand. 132:551–65. PMID: 5339635.
24. Gould N, Seligson D, Gassman J. 1980; Early and late repair of lateral ligament of the ankle. Foot Ankle. 1:84–9. doi: 10.1177/107110078000100206. DOI: 10.1177/107110078000100206. PMID: 7274903.
Article
25. Wainright WB, Spritzer CE, Lee JY, Easley ME, DeOrio JK, Nunley JA, et al. 2012; The effect of modified Broström-Gould repair for lateral ankle instability on in vivo tibiotalar kinematics. Am J Sports Med. 40:2099–104. doi: 10.1177/0363546512454840. DOI: 10.1177/0363546512454840. PMID: 22886690. PMCID: PMC3535340.
Article
26. Karlsson J, Bergsten T, Lansinger O, Peterson L. 1988; Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am. 70:581–8. DOI: 10.2106/00004623-198870040-00015. PMID: 3356725.
Article
27. Paden MH, Stone PA, McGarry JJ. 1994; Modified Brostrom lateral ankle stabilization utilizing an implantable anchoring system. J Foot Ankle Surg. 33:617–22. PMID: 7894411.
28. Hu CY, Lee KB, Song EK, Kim MS, Park KS. 2013; Comparison of bone tunnel and suture anchor techniques in the modified Broström procedure for chronic lateral ankle instability. Am J Sports Med. 41:1877–84. doi: 10.1177/0363546513490647. DOI: 10.1177/0363546513490647. PMID: 23729687.
Article
29. Cho BK, Kim YM, Park KJ, Park JK, Kim DK. 2015; A prospective outcome and cost-effectiveness comparison between two ligament reattachment techniques using suture anchors for chronic ankle instability. Foot Ankle Int. 36:172–9. doi: 10.1177/1071100714552079. DOI: 10.1177/1071100714552079. PMID: 25237170.
Article
30. Sammarco GJ, DiRaimondo CV. 1988; Surgical treatment of lateral ankle instability syndrome. Am J Sports Med. 16:501–11. doi: 10.1177/036354658801600513. DOI: 10.1177/036354658801600513. PMID: 3189684.
Article
31. Kibler WB. 1996; Arthroscopic findings in ankle ligament reconstruction. Clin Sports Med. 15:799–804. https://doi.org/10.1016/S0278-5919(20)30088-0. DOI: 10.1016/S0278-5919(20)30088-0. PMID: 8891409.
32. Okuda R, Kinoshita M, Morikawa J, Yasuda T, Abe M. 2005; Arthroscopic findings in chronic lateral ankle instability: do focal chondral lesions influence the results of ligament reconstruction? Am J Sports Med. 33:35–42. doi: 10.1177/0363546504271058. DOI: 10.1177/0363546504271058. PMID: 15610997.
33. Taga I, Shino K, Inoue M, Nakata K, Maeda A. 1993; Articular cartilage lesions in ankles with lateral ligament injury. An arthroscopic study. Am J Sports Med. 21:120–6. discussion 126–7. doi: 10.1177/036354659302100120. DOI: 10.1177/036354659302100120. PMID: 8427352.
34. Yasui Y, Murawski CD, Wollstein A, Kennedy JG. 2017; Reoperation rates following ankle ligament procedures performed with and without concomitant arthroscopic procedures. Knee Surg Sports Traumatol Arthrosc. 25:1908–15. doi: 10.1007/s00167-016-4207-x. DOI: 10.1007/s00167-016-4207-x. PMID: 27311448.
Article
35. Ferkel RD, Small HN, Gittins JE. 2001; Complications in foot and ankle arthroscopy. Clin Orthop Relat Res. (391):89–104. doi: 10.1097/00003086-200110000-00010. DOI: 10.1097/00003086-200110000-00010. PMID: 11603693.
Article
36. Imade S, Takao M, Miyamoto W, Nishi H, Uchio Y. 2009; Leg anterior compartment syndrome following ankle arthroscopy after Maisonneuve fracture. Arthroscopy. 25:215–8. doi: 10.1016/j.arthro.2007.08.027. DOI: 10.1016/j.arthro.2007.08.027. PMID: 19171284.
Article
37. Oloff LM, Bocko AP, Fanton G. 2000; Arthroscopic monopolar radiofrequency thermal stabilization for chronic lateral ankle instability: a preliminary report on 10 cases. J Foot Ankle Surg. 39:144–53. doi: 10.1016/s1067-2516(00)80015-0. DOI: 10.1016/S1067-2516(00)80015-0. PMID: 10862385.
Article
38. Maiotti M, Massoni C, Tarantino U. 2005; The use of arthroscopic thermal shrinkage to treat chronic lateral ankle instability in young athletes. Arthroscopy. 21:751–7. doi: 10.1016/j.arthro.2005.03.016. DOI: 10.1016/j.arthro.2005.03.016. PMID: 15944635.
Article
39. Cottom JM, Rigby RB. 2013; The "all inside" arthroscopic Broström procedure: a prospective study of 40 consecutive patients. J Foot Ankle Surg. 52:568–74. doi: 10.1053/j.jfas.2013.02.022. DOI: 10.1053/j.jfas.2013.02.022. PMID: 23669003.
Article
40. Guelfi M, Nunes GA, Malagelada F, Cordier G, Dalmau-Pastor M, Vega J. 2020; Arthroscopic-assisted versus all-arthroscopic ankle stabilization technique. Foot Ankle Int. 41:1360–7. doi: 10.1177/1071100720938672. DOI: 10.1177/1071100720938672. PMID: 32660270.
Article
41. Ahn J, Choi JG, Jeong BO. 2020; August. 8. The signal intensity of preoperative magnetic resonance imaging has predictive value for determining the arthroscopic reparability of the anterior talofibular ligament. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-020-06208-w. DOI: 10.1007/s00167-020-06208-w. PMID: 32770383.
Article
42. Drakos MC, Behrens SB, Paller D, Murphy C, DiGiovanni CW. 2014; Biomechanical comparison of an open vs arthroscopic approach for lateral ankle instability. Foot Ankle Int. 35:809–15. doi: 10.1177/1071100714535765. DOI: 10.1177/1071100714535765. PMID: 24850160.
Article
43. Giza E, Shin EC, Wong SE, Acevedo JI, Mangone PG, Olson K, et al. 2013; Arthroscopic suture anchor repair of the lateral ligament ankle complex: a cadaveric study. Am J Sports Med. 41:2567–72. doi: 10.1177/0363546513500639. DOI: 10.1177/0363546513500639. PMID: 23982396.
44. Lee KT, Kim ES, Kim YH, Ryu JS, Rhyu IJ, Lee YK. 2016; All-inside arthroscopic modified Broström operation for chronic ankle instability: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 24:1096–100. doi: 10.1007/s00167-014-3159-2. DOI: 10.1007/s00167-014-3159-2. PMID: 24996867.
Article
45. Matsui K, Takao M, Miyamoto W, Matsushita T. 2016; Early recovery after arthroscopic repair compared to open repair of the anterior talofibular ligament for lateral instability of the ankle. Arch Orthop Trauma Surg. 136:93–100. doi: 10.1007/s00402-015-2342-3. DOI: 10.1007/s00402-015-2342-3. PMID: 26467354.
Article
46. Yeo ED, Lee KT, Sung IH, Lee SG, Lee YK. 2016; Comparison of all-inside arthroscopic and open techniques for the modified Broström procedure for ankle instability. Foot Ankle Int. 37:1037–45. doi: 10.1177/1071100716666508. DOI: 10.1177/1071100716666508. PMID: 27623732.
Article
47. Guelfi M, Zamperetti M, Pantalone A, Usuelli FG, Salini V, Oliva XM. 2018; Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability: a systematic review. Foot Ankle Surg. 24:11–8. doi: 10.1016/j.fas.2016.05.315. DOI: 10.1016/j.fas.2016.05.315. PMID: 29413768.
Article
48. Brown AJ, Shimozono Y, Hurley ET, Kennedy JG. 2020; Arthroscopic versus open repair of lateral ankle ligament for chronic lateral ankle instability: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 28:1611–8. doi: 10.1007/s00167-018-5100-6. DOI: 10.1007/s00167-018-5100-6. PMID: 30109370.
Article
49. Acevedo JI, Ortiz C, Golano P, Nery C. 2015; ArthroBroström lateral ankle stabilization technique: an anatomic study. Am J Sports Med. 43:2564–71. doi: 10.1177/0363546515597464. DOI: 10.1177/0363546515597464. PMID: 26306779.
50. Guelfi M, Vega J, Malagelada F, Dalmau-Pastor M. 2020; The arthroscopic all-inside ankle lateral collateral ligament repair is a safe and reproducible technique. Knee Surg Sports Traumatol Arthrosc. 28:63–9. doi: 10.1007/s00167-019-05427-0. DOI: 10.1007/s00167-019-05427-0. PMID: 30830298.
Article
Full Text Links
  • JKFAS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr