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Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair

  • ANKLE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The relationship between ligament remnant quality and postoperative outcomes after arthroscopic lateral ankle ligament repair for chronic lateral ankle instability is controversial. This study aimed to determine whether the signal intensity of the anterior talofibular ligament on preoperative magnetic resonance imaging and ligament remnant quality identified on arthroscopy are associated with recurrent ankle instability after arthroscopic lateral ankle ligament repair.

Methods

A total of 68 ankles from 67 patients with chronic lateral ankle instability who underwent arthroscopic lateral ankle ligament repair were retrospectively studied. The signal intensity of the anterior talofibular ligament was evaluated using T2-weighted magnetic resonance imaging. Arthroscopy was used to evaluate the thickness and mechanical resistance of the anterior talofibular ligament by hook palpation and to classify ankles into two groups: the present anterior talofibular ligament group with adequate mechanical resistance and the absent anterior talofibular ligament group with no mechanical resistance. The outcomes included recurrent ankle instability (respraining of the operated ankle after surgery) and Self-Administered Foot Evaluation Questionnaire scores.

Results

Thirteen ankles were diagnosed with recurrent ankle instability. Patients with a high anterior talofibular ligament T2 signal intensity experienced more recurrent ankle instability than those with a low intensity. As determined via arthroscopy, the absent anterior talofibular ligament group had a higher rate of recurrent ankle instability than the present anterior talofibular ligament group. There were no significant differences in Self-Administered Foot Evaluation Questionnaire scores between patients with high and low anterior talofibular ligament T2 signal intensity, as well as between absent and present anterior talofibular ligament groups based on arthroscopy.

Conclusion

Poor quality of the anterior talofibular ligament remnant could result in recurrent ankle instability after arthroscopic lateral ankle ligament repair. Therefore, when treating chronic lateral ankle instability, surgeons should consider ligament quality.

Level of Evidence

IV.

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Data availability

The data that support the findings of this study are available from the corresponding author, MN, upon reasonable request.

Abbreviations

acAL:

Accessory anterolateral

ATFL:

Anterior talofibular ligament

BMI:

Body mass index

CLAI:

Chronic lateral ankle instability

MRI:

Magnetic resonance imaging

SAFE-Q:

Self-Administered Foot Evaluation Questionnaire

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Acknowledgements

We thank Enago (https://www.enago.jp/) for editing a draft of this manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-0054, Japan

    Kensei Yoshimoto, Masahiko Noguchi, Ayako Tominaga & Ken Okazaki

  2. Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-Ku, Tokyo, 157-8550, Japan

    Kensei Yoshimoto, Masahiko Noguchi, Hideyuki Maruki, Ayako Tominaga & Mina Ishibashi

  3. Department of Orthopaedic Surgery, Saitama Medical University Hospital, Moroyama, Saitama, Japan

    Masahiko Noguchi & Hideyuki Maruki

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  1. Kensei Yoshimoto
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Contributions

KY and MN contributed to the conception and design of the manuscript, decision-making regarding the treatment protocol, acquisition of data, and manuscript preparation. HM, AT, and MI contributed to decision-making regarding the treatment protocol and acquisition of data and participated in the surgeries. KO made valuable suggestions regarding the design and conception of the study. All authors critically reviewed the manuscript, approved the final version of the manuscript, and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Masahiko Noguchi.

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The authors declare that they have no competing interests.

Ethical approval

This study was approved by the institutional review board at Shiseikai Daini Hospital (IRB number: 130).

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Informed consent was obtained from all patients.

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Yoshimoto, K., Noguchi, M., Maruki, H. et al. Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair. Knee Surg Sports Traumatol Arthrosc 31, 2183–2191 (2023). https://doi.org/10.1007/s00167-022-07211-z

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