Summary

The arthroscopic all-inside ligament repair is an effective and safe option for ankle instability in skeletally immature patients with minimal risk of clinically significant physeal complications.

Abstract

Purpose

The arthroscopic all-inside ligament repair is a popular technique used to treat chronic lateral ankle instability. The aim of this study was to evaluate clinical outcomes in skeletally immature patients who underwent all-inside ligament repair for chronic ankle instability.

Methods

35 patients aged between 13 and 17 years (18 women, median age 14.5), were enrolled and retrospectively evaluated. Patients underwent arthroscopic treatment after failing nonoperative management for at least 6 months between 2018 and 2023. During arthroscopy, the injured ligaments were repaired with an arthroscopic all-inside (AI) technique. The AI technique allows an all-epiphyseal anatomical repair of the ligament remnant without physeal violation. The median follow-up was 40 (range, 72-13) months. Clinically, the patients were evaluated pre- and post-operatively with VAS, FFI and FAAM-SS. At final follow-up satisfaction, complications and clinical length or malalignment of the lower limbs were also valuated. Ankle MRI and weight-bearing X-rays were taken preoperatively.

Results

A tear affecting the ATFL was observed in all cases. In addition, 8 patients were diagnosed with a concomitant calcaneofibular ligament detachment and in two patients an injury of the medial collateral ligament was observed. Clinical scores showed significant (P < 0.01) improvement: mean FFI and FAAM-SS scores improved from 28.8 [range,11-40] and 45.8 [range, 15-78], respectively, to 1.6 [range, 0-16] and 95.8 [range, 60-100] after surgery. VAS score improved from a mean of 5.6 [range, 2-9] pre-operatively to a mean of 0.1 [range, 0-3] at follow-up (P < 0.01).
No major complications, stiffness and axial deviations were clinically observed. All patients were satisfied except for 1 patient in which surgery did not meet expectations. In 3 patients a minor ankle sprain managed conservatively occurred. However, no recurrence of ankle instability or persistent pain were observed.

Conclusion

This study demonstrates that the arthroscopic all-inside ligament repair is an effective and safe option for ankle instability in skeletally immature patients with minimal risk of clinically significant physeal complications. Therefore, given the harmfulness of a chronic ankle instability in adolescent patients, a ligament repair is highly recommended in case of ankle instability.