Can Calcaneofibular Ligament Repair Correct Hindfoot Varus Alignment in the Management of Chronic Lateral Ankle Instability?

BACKGROUND

Hindfoot varus alignment is a risk factor for chronic lateral ankle instability (CLAI) and recurrent ankle instability following anterior talofibular ligament (ATFL) repair for CLAI. This study aimed to assess whether combining calcaneofibular ligament (CFL) repair with ATFL repair can correct hindfoot varus alignment and reduce recurrent ankle instability.

METHODS

This study retrospectively examined 74 ankles from 71 patients with hindfoot varus alignment who had lateral ankle ligament repair for CLAI. Arthroscopic ATFL repair was performed on 37 ankles (from 36 patients) between 2018 and 2021 (ATFL-only group), whereas open ATFL and CFL repair were conducted on another 37 ankles (from 35 patients) between 2021 and 2023 (CFL-repair group). Long axial hindfoot alignment radiographs were utilized to measure tibiocalcaneal angles (TCA) pre- and postoperatively. The primary outcome includes recurrent ankle instability (i.e., respraining of the operated ankle after surgery), whereas the secondary outcome involves Self-Administered Foot Evaluation Questionnaire (SAFE-Q) scores.

RESULTS

A comparison of patient demographics between the two groups revealed no marked differences. Additionally, pre- and postoperative TCA demonstrated that neither ATFL repair only nor CFL repair combined with ATFL repair corrected hindfoot varus alignment. Furthermore, no significant differences were observed in postoperative recurrent ankle instability and SAFE-Q scores between the two groups.

CONCLUSION

Combining ATFL and CFL repair could not correct hindfoot varus alignment, and this procedure for CLAI with hindfoot varus alignment was not more effective in reducing recurrent ankle instability than ATFL repair alone.