ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper


Additional Inferior Extensor Retinaculum Augmentation after All-inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability Is Not Necessary

Sung Hyun Lee, Prof., Iksan-Si, Jeollabuk-do KOREA, REPUBLIC OF
Bong Jun Jang, MD, Iksan KOREA, REPUBLIC OF

Wonkwang University, Collage of Medicine, Iksan, KOREA, REPUBLIC OF

FDA Status Not Applicable


Additional inferior extensor retinaculum augmentation after arthroscopic anterior talofibular ligament repair did not guarantee better clinical outcomes



Although several arthroscopic surgical techniques for the treatment of chronic ankle lateral instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear.


The purpose of this study was to compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not.

Study Design
Cohort study. Level of evidence: 3.


Between 2016 and 2018, we performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI. The mean age of the patients was 35.2 years (range, 19–51 years), and the mean follow-up period was 32.6 months (range, 24–48 months). Patients were divided into two groups according to the surgical technique used for CAI: Arthroscopic ATFL repair (group A, n = 37), and arthroscopic ATFL repair with additional IER augmentation (group R, n = 45). The Pain Visual Analog Scale, American Orthopedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome score (FAOS), and the Karlsson Ankle Functional Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view MRI.


A total of consecutive 101 patients, 19 (18.5%) patients were excluded base on exclusion criteria, and 82 patients were evaluated. We identified a total of six re-tears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL re-tear on MRI (8.1% [3/37] in group A, and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement > 3 mm compared to the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups (P < 0.001). However, there were no significant differences in the clinical results and radiologic findings between the two groups.


The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.

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