Arthroscopic Reconstruction of the Anterior Talofibular Ligament and Calcaneofibular Ligament Using Allograft for Chronic Lateral Ankle Instability Allows Patients to Successfully Return to Their Preinjury Sports Activities With Excellent Clinical Outcome at Minimum 2-Year Follow-Up

Purpose

To report and evaluate the time of return to work and sports of patients who underwent an anatomic arthroscopic reconstruction using allograft for chronic lateral ankle instability (CLAI) through 2 portals, and to analyze the functional results as well as the postoperative complications of the reconstruction surgery.

Methods

We retrospectively reviewed patients who underwent allograft arthroscopic reconstruction of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in the period from January 2018 to January 2022. The inclusion criteria encompassed patients with CLAI who (1) were older than 18 years old; (2) underwent arthroscopic ATFL and CFL reconstruction using allograft; and (3) had been followed up for at least 2 years. The operation was performed with 2 arthroscopic portals, a percutaneous incision for CFL reconstruction, and 2 knotless anchors. Time of return to work and sports was recorded. In addition, Karlsson Ankle Functional Score (KAFS), Tegner Activity Scale (TAS), visual analog pain scale (VAS), and visual analog scale for patient satisfaction (VASPS) were evaluated preoperatively and postoperatively, and all complications were documented at a minimum follow up of 2 years.

Results

In total, 44 patients (mean age, 35.6 ± 9.7 years) were included, and the average follow-up duration was 29.6 ± 3.7 months (range, 24-42 months). The mean time of return to work was 3.29 ± 0.93 months, whereas the mean time of return to sports was 6.45 ± 1.55 months. KAFS increased from 53.91 ± 9.31 to 91.14 ± 6.03 (P < .001), mean TAS increased from 2.22 ± 1.05 to 7.34 ± 1.51 (P < .001), VAS decreased from 3.95 ± 1.71 to 0.43 ± 0.66 (P < .001), and VASPS increased from 1.11 ± 1.43 to 9.59 ± 0.76 (P < .001). All patients (100%) achieved the minimal clinically important difference in KAFS, VAS, TAS, and VASPS. Subgroup analysis indicated no statistically significant differences in functional outcomes regarding the presence/absence of associated intra-articular lesions and body mass index (greater or less than 25). Minor complications were observed in only 4 patients (9.1%).

Conclusions

Patients with CLAI who underwent arthroscopic allograft reconstruction of ATFL and CFL through 2 portals and an additional incision successfully returned to their preinjury occupations within 5 months. They also returned to their preinjury level of sports without restrictions, adaptations, or protective measures within 9 months. They showed excellent clinical outcomes, as all patients (100%) achieved the minimal clinically important difference in KAFS, VAS, TAS, and VASPS at minimum of 24 months follow-up. However, 9.1% of patients had minor neurologic complications.

Level of Evidence

Level IV, retrospective therapeutic case series.