Clinical Results of All-Inside Lateral Ankle Ligament Complex Repair were Comparable to Open Brostrom Procedure in High-Demand Patients with Chronic Ankle Instability: Randomized Controlled Study

Category: Ankle; Arthroscopy Introduction/Purpose: The open modified Broström-Gould procedure is widely accepted as the reference standard for lateral ankle stabilization. However, there is a lack of research comparing the outcomes of arthroscopic repair and open repair procedures for chronic ankle instability (CAI), despite the increasing number of publications on arthroscopic repair of the anterior talofibular ligament (ATFL). This study aimed to compare the clinical and radiological outcomes of arthroscopic repair and open repair of the lateral ligament complex (LLC) in patients with CAI. Methods: We prospectively randomized 64 patients who underwent ligament repair surgery for CAI into two groups: arthroscopic LLC repair (group A, 33 patients) and open modified Broström-Gould procedure (group O, 31 patients). High-demand patients, as determined by a Tegner Activity level ≥ 6, with CAI were included. Subjective outcomes were measured using the pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score. Posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic evaluations were conducted preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). A subgroup analysis was also performed according to arthroscopic ligament quality (excellent to fair vs. poor). Results: Both groups showed significant improvements in all clinical scores, objective posturography results, and stress radiographs at 2 years postoperatively (all p < 0.05), with no significant differences between the groups in terms of preoperative and postoperative values (all p > 0.05). Additionally, we identified 5 cases of retear (7.8%) based on postoperative MRI evaluation (9.1% [3/33] in group A and 6.5% [2/31] in group O). One patient in group O experienced postoperative soft tissue infection. However, there were no significant differences between the two groups (p > 0.05). There was no difference in clinical results between each group in subgroup analysis according to ligament quality (p > 0.05). Conclusion: Arthroscopic LLC repair produced similarly favorable outcomes when compared with open lateral ankle ligament repair. In addition, arthroscopic LLC repair, as a minimally invasive technique, provide comparable outcomes to open procedure, even when the ligament tissue was poor.