Primary Lateral Ankle Ligament Repair is Associated with Increased Reoperation Rates Compared to Secondary Lateral Ankle Ligament Reconstruction: A Propensity-Matched Analysis

Category: Ankle; Sports Introduction/Purpose: Lateral ankle ligament stabilization is indicated for patients with chronic ankle instability that persists despite nonoperative management. The purpose of this investigation was to compare reoperation rates in patients who underwent a primary repair versus those who underwent a secondary reconstruction of the lateral ankle ligaments. Methods: A large, nationwide insurance database was retrospectively reviewed to identify all patients who underwent isolated primary repair and/or secondary reconstruction of the lateral ankle ligamentous complex from 2010 and 2019. Patients who underwent primary repair were matched using a propensity-scoring algorithm to patients who underwent secondary lateral ankle reconstruction. Reoperation rates including ankle arthroscopy and revision lateral ankle ligament repair/reconstruction were compared between groups at two years postoperatively. Complication rates within 90 days postoperatively were also evaluated and compared between groups. Results: 41,452 patients who underwent primary lateral ankle ligament repair were matched to 41,452 patients who underwent secondary reconstruction. Patients who underwent primary repair had an increased risk of undergoing a subsequent ankle arthroscopy (OR: 1.15; p < 0.001) or revision stabilization procedure (OR: 1.30; p < 0.001) within two years postoperatively. Moreover, the risks of sustaining complications such as wound dehiscence (OR 1.34; p < 0.001) or surgical site infection (OR 1.43; p = 0.008) within 90 days were higher for the primary ligament repair group compared to the secondary reconstruction group. Conclusion: Patients who underwent primary lateral ankle ligament repair were more likely to require subsequent ankle arthroscopy or revision ankle stabilization within two years postoperatively, compared to those who underwent secondary reconstruction of the lateral ankle ligament complex. Although secondary reconstruction procedures (e.g. Watson-Jones, Colville) are conventionally utilized in the revision setting, surgeons may consider expanding the indications for reconstruction to the primary setting, particularly in surgical candidates who are identified preoperatively as high-risk for recurrent instability.