Arthroscopy with lateral ankle ligament stabilization: benefit versus cost comparison

Objective: Compare the differences in cost, complications, new intra-articular diagnoses, and reoperations among patients with ankle instability submitted to lateral ankle ligament repair/reconstruction with or without arthroscopic procedures. Methods: A retrospective analysis of 2,428 patients from the PearlDiver Humana dataset with ankle sprain or instability codes and compared outcomes between those submitted to lateral ankle ligament repair/reconstruction with or without arthroscopy. Results: Patients without arthroscopy had higher complication rates (9.87% vs. 5.41%; χ2[1, n = 1,236] = 5.83, p = 0.01), while the difference in reconstruction groups was insignificant (p = 0.09). Arthroscopy groups had higher rates of newly diagnosed intra-articular pathology: repair with arthroscopy (57.0%) vs. without (35.6%; χ2[1, n = 1,236] = 44.47, p < 0.001); reconstruction with arthroscopy (63.0%) vs. without (39.8%; χ2[1, n = 1,211] = 61.90, p < 0.001). Reoperation rates for intra-articular pathology were higher in the arthroscopy group (6.89% vs. 4.18%; χ2[1, n = 2,433] = 8.09, p = 0.006), with significantly shorter time to reoperation (303 vs. 474 days, p = 0.045). Conclusions: Arthroscopy does not increase complication rates and allows for earlier diagnosis and treatment of intra-articular pathology, potentially leading to earlier reoperation. Level of evidence III; Retrospective Comparative Study.