Background
Short term results after arthroscopic/endoscopic lateral ligament repair for chronic lateral ankle instability has been satisfactory although medium to longer term results are lacking. This study aims to report the medium term results an all-inside endoscopic classic Bröstrom-Gould procedure where both the both lateral ligaments and the inferior extensor retinaculum can be approached directly interchanging between arthroscopy for intracapsular structures and endoscopy for extracapsular structures. The hypothesis is that the all-inside endoscopic classic Bröstrom-Gould procedure can produce sustainable good outcomes at a medium term of 5 years.
Methods
A prospective database for 43 patients that underwent the all-inside endoscopic classic Bröstrom-Gould repair of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) with inferior extensor retinaculum (IER) augmentation was reviewed. Demographic details, American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson score, ankle activity score (AAS) and patient satisfaction were collected and analysed.
Results
The study cohort of 43 patients with an average age of 29.4 ± 11.9 years old were reviewed at an average follow-up of 63.1 ± 8.5 months. The AOFAS scores showed significant improvement from 69.6 ± 13.9 to 93.7 ± 10.7 while the Karlsson score improved from 59.7 ± 14.5 to 91.5 ± 14.5 at the final follow-up. The AAS showed that 32 (74.4%) patients maintained or had improvement in the AAS at 5.41 ± 2.8 from 5.38 ± 2.8 with an average satisfaction rate of 9.1 ± 1.3. Although the remaining 11 patients had reduced AAS at 4.6 ± 2.6, they reported an average satisfaction rate of 7.4 ± 2.9. There were no surgical complications or reoperations reported in this cohort although there were 3 patients with recurrent instability at their last follow-up resulting in a failure rate of 7%.
Conclusion
The current study is the first to report the medium term outcomes of an all-inside endoscopic classic Bröstrom-Gould procedure. 93% of the patients had good functional outcomes but approximately 25% of patients had decreased ankle activity levels at an average of 5 years postoperatively albeit with good satisfaction rates.