Results of arthroscopic lateral ligament repair according to the arthroscopic classification of anterior talofibular ligament remnants

Background: This study aimed to compare the clinical and radiologic outcomes among grades according to the arthroscopic classification of chronic ATFL lesions after arthroscopic lateral ligament repair.

Methods: We retrospectively analyzed 135 patients with chronic lateral ankle instability who underwent arthroscopic lateral ligament repair at 3 institutions between 2018 and 2020. The patients were divided into four groups according to the arthroscopic classification of the ATFL remnants. The Karlsson ankle functional score (KAFS) and foot and ankle outcome score (FAOS) were evaluated preoperatively and at the last follow-up. On stress radiographs, the talar tilt and anterior talar translation were measured preoperatively and at the last follow-up.

Results: Of the 135 included patients, 41 (30.4 %), 42 (31.1 %), 34 (25.2 %), and 18 (13.3 %) were in groups 1, 2, 3, and 4, respectively. There were no significant differences among the groups with respect to the preoperative patient characteristics, except for concomitant injuries. The mean KAFS and FAOS improved significantly at the last follow-up in all groups; however, no significant differences occurred among the groups in any scores preoperatively or at the last follow-up. The mean talar tilt and anterior talar translation decreased significantly at the last follow-up in all the groups. Group 1 exhibited significantly less preoperative talar tilt than that in the other groups (P < .001). However, no significant difference occurred in talar tilt among the groups at the last follow-up. There were no differences among the groups in the preoperative anterior talar translation or values at the last follow-up.

Conclusions: The present study demonstrated that arthroscopic lateral ligament repair showed good functional and stress radiographic outcomes regardless of the quality of ATFL remnant.