Ligament Quality Predicts Recurrence and Functional Outcomes After Arthroscopic All-Inside Anterior Talofibular Ligament Repair.

PURPOSE

To evaluate the clinical outcomes of arthroscopic all-inside anterior talofibular ligament (ATFL) repair on the basis of the quality of the remnant ATFL.

METHODS

We retrospectively analyzed consecutive patients with chronic ankle instability who underwent arthroscopic ATFL repair with a minimum follow-up period of 24 months. Patients were categorized into 2 groups on the basis of the arthroscopic ATFL grade: group G, characterized by good-to-moderate tissue quality with distension or ATFL discontinuity; and group P, characterized by poor tissue quality with a hypoplastic ATFL. Outcome measurements were obtained preoperatively and postoperatively. Patients-reported outcomes were assessed using the visual analog scale score, Foot and Ankle Outcome Score (FAOS), and Karlsson ankle functional score. Objective outcomes included posturographic analysis and radiologic evaluations, such as stress radiographs and axial view magnetic resonance imaging.

RESULTS

Both groups exhibited postoperative improvements in the subjective and objective clinical outcomes (all P < .05). For the sports unit of FAOS, 75.3% of group G exceeded the minimal clinically important difference threshold, compared with 57.8% of group P, showing a statistically significant difference (P = .027). Group P had significantly lower FAOS scores in the sports unit (group G: 86.9 ± 32.8, group P: 61.9 ± 26.4, P = .016), an increased fall risk as determined using posturography at the final follow-up (group G: 28.6 ± 22.4, group P: 49.7 ± 23.3, P = .019), and a greater retear rate on axial-view MRI (group G: 2.6%, 2/77, group P: 10.9%, 7/64, P = .044).

CONCLUSIONS

Arthroscopic all-inside ATFL repair is an effective treatment for chronic ankle instability, regardless of the quality of the remnant ligament. However, patients with poor ligament quality have inferior clinical outcomes, particularly in terms of sports-related activities, as reflected by both lower scores and fewer patients exceeding the minimal clinically important difference threshold. In addition, the fall risk index and retear rates were greater in patients with poor ligament quality, highlighting the impact of ligament quality on postoperative stability and functional recovery.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.