Arthroscopic assisted anterior talo-fibular ligament (ATFL) reconstruction with InternalBrace™ augmentation

N. Gogi, B. Ayaswamy, E. Alderton, L. McPartlin, R. Limaye

Background: Lateral ankle sprain are the commonest ankle injuries comprising up to 85% of all ankle injuries. The usual mode of injury is twisting / sports injury. The ATFL is the commonest involved structure, though the Calcaneo-fibular ligament (CFL) and Posterior Talo-fibular ligament (PTFL) may be also involved in some.  Most of them are successfully treated conservatively, however, 20 – 30% may land up with chronic instability. Anatomical repair has been the mainstay of treatment but has longer recovery period with occasional recurrence. We present our study which involved anatomical repair (Modified Brostrom Gould) with InternalBrace™ augmentation.
 

Methods: Our study was a retrospective, single centre study comprising of 72 patients over a period of 2 years. The patients included had failed conservative therapy at 6 months post injury. Only adult patients with no previous ankle surgery / injury were included. Sixty-one patients fulfilled our inclusion criteria, with an average age of 37.5 (14.7 SD) years, predominantly females 42 (68.8%). Mode of injury was almost all due to simple twisting / sports injury and time to surgery was on an average of 14.1 months. Mean follow up was 14.6 (6-30 months).
 

Results: The visual analogue scores for pain improved from 6.3 (1.1SD) to 1.7 (1.4SD) and the MOXFQ from 62.1 (9.2 SD) to 18.2 (20.4 SD), both statistically significant. Patient subjective satisfaction was ‘Good – Excellent’ in 54 (88.5%) patients with most achieving pre-injury activity level at 12.5 (2.3SD) weeks. We had 5 patients with complications – 2 had persistent instability (BMI >40 + Hypermobility), 1 had infection, 1 had Complex Regional Pain Syndrome and 1 failed due to re-injury.
 

Conclusion: We conclude that Arthroscopic assisted ATFL reconstruction with InternalBrace™ augmentation is a reproduceable, safe and successful procedure for lateral ankle instability and significantly reduces the rehabilitation times for patients.