PURPOSE: To compare the clinical outcomes of the lasso-loop and simple suture techniques in arthroscopic anterior talofibular ligament (ATFL) repair for the treatment of chronic lateral ankle instability (CLAI).
METHODS: From 2018 to 2020, patients with CLAI who underwent arthroscopic ATFL repair using the lasso-loop or simple suture technique were matched 1:1 (arthroscopic lasso-loop [AL] group, n = 29; simple arthroscopic suture [AS] group, n = 29) based on age, sex, affected side, body mass index, and follow-up duration using propensity score matching and retrospectively evaluated. Karlsson score, visual analogue scale (VAS) score, Tegner score, anterior drawer test (ADT) results, complications, patient-reported satisfaction, and magnetic resonance (MR) re-evaluation findings of ATFL quality were used to describe the outcomes.
RESULTS: The patient characteristics or follow-up durations did not significantly differ between the two groups. The Karlsson score, VAS score, and Tegner score improved significantly in both groups after a mean follow-up duration of 29.6 ± 2.8 months. The postoperative clinical scores, ADT results, satisfaction rates, complication rates and MR re-evaluation findings were not significantly different between the two groups at the latest follow-up.
CONCLUSION: The lasso-loop technique was equivalent to the simple suture technique in arthroscopic ATFL repair for the treatment of CLAI after a minimum follow-up of 2 years, suggesting that the simple suture technique is sufficient for arthroscopic ATFL repair in most patients without the need to add a lasso loop.
LEVEL OF EVIDENCE: Level III.
Acevedo JI, Mangone PG (2021) Arthroscopic surgical technique for lateral ankle ligament instability. Foot Ankle Clin 26:65–85
[DOI:
10.1016/j.fcl.2020.10.004]
Aicale R, Maffulli N (2020) Chronic lateral ankle instability: topical review. Foot Ankle Int 41:1571–1581
[DOI:
10.1177/1071100720962803]
Brown AJ, Shimozono Y, Hurley ET, Kennedy JG (2020) Arthroscopic versus open repair of lateral ankle ligament for chronic lateral ankle instability: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 28:1611–1618
[DOI:
10.1007/s00167-018-5100-6]
Cordier G, Nunes GA, Vega J, Roure F, Dalmau-Pastor M (2021) Connecting fibers between ATFL’s inferior fascicle and CFL transmit tension between both ligaments. Knee Surg Sports Traumatol Arthrosc 29:2511–2516
[DOI:
10.1007/s00167-021-06496-w]
Giza E, Shin EC, Wong SE et al (2013) Arthroscopic suture anchor repair of the lateral ligament ankle complex: a cadaveric study. Am J Sports Med 41:2567–2572
[DOI:
10.1177/0363546513500639]
Gribble PA, Delahunt E, Bleakley C et al (2013) Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the international ankle Consortium. J Orthop Sports Phys Ther 43:585–591
[DOI:
10.2519/jospt.2013.0303]
Guo H, Huang WQ, Lin XJ, Chen BT, Zeng CJ (2020) Validation of a Chinese translation of the identification of functional ankle instability questionnaire. Chin Med J (Engl) 133:2261–2262
[DOI:
10.1097/CM9.0000000000001020]
Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA (2019) Epidemiology of ankle sprains and chronic ankle instability. J Athl Train 54:603–610
[DOI:
10.4085/1062-6050-447-17]
Hunt KJ, Hurwit D (2013) Use of patient-reported outcome measures in foot and ankle research. J Bone Jt Surg Am 95:e118(1-9)
[DOI:
10.2106/JBJS.L.01476]
Li H, Hua Y, Li H, Ma K, Li S, Chen S (2017) Activity level and function 2 years after anterior talofibular ligament repair: a comparison between arthroscopic repair and open repair procedures. Am J Sports Med 45:2044–2051
[DOI:
10.1177/0363546517698675]
Malinowski K, Paszkowski J, Goralczyk A, Giza E, Hermanowicz K (2020) Arthroscopic anatomic anterior talofibular ligament repair for anterolateral ankle instability. Arthrosc Tech 9:e29–e33
[DOI:
10.1016/j.eats.2019.08.008]
Mederake M, Hofmann UK, Ipach I (2022) Arthroscopic modified Broström operation versus open reconstruction with local periosteal flap in chronic ankle instability. Arch Orthop Trauma Surg 142:3581–3588
[DOI:
10.1007/s00402-021-03949-2]
Michels F, Pereira H, Calder J et al (2018) Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert. Knee Surg Sports Traumatol Arthrosc 26:2095–2102
[DOI:
10.1007/s00167-017-4556-0]
Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N (2011) Arthroscopic-assisted Broström-Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med 39:2381–2388
[DOI:
10.1177/0363546511416069]
Nishimura A, Nakazora S, Senga Y et al (2021) Arthroscopic internal brace augmentation with arthroscopic modified Broström operation for chronic ankle instability. Arthrosc Tech 10:e995–e1000
[DOI:
10.1016/j.eats.2020.11.021]
Pacheco J, Guerra-Pinto F, Araujo L et al (2021) Chronic ankle instability has no correlation with the number of ruptured ligaments in severe anterolateral sprain: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 29:3512–3524
[DOI:
10.1007/s00167-021-06610-y]
Pellegrini MJ, Sevillano J, Ortiz C, Giza E, Carcuro G (2019) Knotless modified arthroscopic-Broström technique for ankle instability. Foot Ankle Int 40:475–483
[DOI:
10.1177/1071100718820341]
Ponce BA, Hosemann CD, Raghava P, Tate JP, Eberhardt AW, Lafosse L (2011) Biomechanical evaluation of 3 arthroscopic self-cinching stitches for shoulder arthroscopy: the lasso-loop, lasso-mattress, and double-cinch stitches. Am J Sports Med 39:188–194
[DOI:
10.1177/0363546510383394]
Samejima Y, Inokuchi R, Iwashita K et al (2021) Arthroscopic ankle lateral ligament repair alone versus arthroscopic ankle lateral ligament repair with reinforcement by inferior extensor retinaculum. Arch Orthop Trauma Surg 141:987–995
[DOI:
10.1007/s00402-021-03771-w]
Takao M, Inokuchi R, Jujo Y et al (2021) Clinical outcomes of concurrent surgery with weight bearing after modified lasso-loop stitch arthroscopic ankle stabilization. Knee Surg Sports Traumatol Arthrosc 29:2006–2014
[DOI:
10.1007/s00167-020-06264-2]
Takao M, Matsui K, Stone JW et al (2016) Arthroscopic anterior talofibular ligament repair for lateral instability of the ankle. Knee Surg Sports Traumatol Arthrosc 24:1003–1006
[DOI:
10.1007/s00167-015-3638-0]
Woo BJ, Lai MC, Koo K (2020) Arthroscopic versus open Broström-Gould repair for chronic ankle instability. Foot Ankle Int 41:647–653
[DOI:
10.1177/1071100720914860]
Yeo ED, Park SB, Lee SW et al (2021) Knotless all-inside arthroscopic modified Broström procedure for lateral ankle instability. J Foot Ankle Surg 60:541–547
[DOI:
10.1053/j.jfas.2020.11.004]
Zeng G, Hu X, Liu W et al (2020) Open Broström-Gould repair vs arthroscopic anatomical repair of the anterior talofibular ligament for chronic lateral ankle instability. Foot Ankle Int 41:44–49
[DOI:
10.1177/1071100719875964]
Zhi X, Zhang Y, Li W et al (2022) Absorbable suture anchor and knotless anchor techniques produced similar outcomes in arthroscopic anterior talofibular ligament repair. Knee Surg Sports Traumatol Arthrosc 30:2158–2165
[DOI:
10.1007/s00167-021-06855-7]
