Outcomes of Arthroscopic Anterior Talofibular Ligament Repair with and without Inferior Extensor Retinaculum Augmentation for Chronic Ankle Instability: A Prospective Randomized Study

Abstract

Category: Sports; Arthroscopy Introduction/Purpose: Although Modified Broström Technique is still gold standard procedure for chronic ankle instability (CAI), the effect of inferior extensor retinaculum (IER) augmentation remains unclear. Recently, as several arthroscopic surgical techniques for CAI have been introduced, the issue on additional IER augmentation has been controversial in the arthroscopic field as well. The purpose of this study was to compare the clinical and radiological outcomes between all-inside arthroscopic anterior talofibular ligament (ATFL) repair with and without IER augmentation. Methods: We prospectively randomized 59 patients who underwent arthroscopic surgery for CAI into 2 groups: arthroscopic ATFL repair with IER augmentation (group W, 29 patients) and without IER augmentation (group WO, 30 patients). The pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging. Results: All clinical scores, objective posturography, and stress radiographs improved significantly at 2 years postoperatively in both groups (all, p0.05). In addition, we identified 3 retear (5.1%) based on postoperative MRI evaluation (3.4% [1/29] in group W and 6.7% [2/30] in group WO). However, there was no significant differences between 2 groups (p>0.05). One patient in group WO had neuralgia of the superficial peroneal nerve; 2 patients in group W had knot irritation causing mild discomfort. Conclusion: Arthroscopic ATFL repair represent good postoperative functional and radiologic outcomes, regardless IER augmentation. Additional IER augmentation after arthroscopic ATFL repair is not promise better clinical outcomes.