Functional Outcome of Anterior Talofibular Ligament Repair Using Bioabsorbable Suture Anchors

CATEGORY: Ankle; Sports INTRODUCTION/PURPOSE: Suture anchors provide an optimal way of fixating injured soft tissue to bone while promoting healing and structural integrity. With recent innovations, the development of biodegradable ultrasonic liquifying suture anchors has been of particular interest. These devices utilize ultrasound energy to liquify a polylactide anchor tip, which is inserted into cancellous bone, at which point it solidifies and fixates within seconds. Mechanical performance testing in comparison to current mainstream devices suggests this method as more suitable for rapid tissue repair and healing. Initial studies have, however, been limited to artificial bone. The current study aims to evaluate surgical and patient-reported outcomes in the use of bio-absorbable suture anchors used for Broström-Gould lateral ankle ligament reconstruction. METHODS: This study consisted of a single-surgeon, retrospective analysis with Institutional Review Board approval (University of Texas Medical Branch (UTMB), August 2 2019). A database search was conducted for patients who underwent primary or secondary Broström-Gould repair indicated for chronic laxity of the anterior talofibular ligament (ATFL) with bioabsorbable suture anchors between May 2017 and May 2019 at UTMB. Exclusion criteria were patient age under 18, incarcerated patient, and patient being a pharmaceutical company employee. Using patient charts, operative and progress notes were reviewed to assess surgical outcomes, concurrent repairs, and complications. Thereafter, patients were contacted via telephone to obtain Patient- Reported Outcomes Measurement Information System (PROMIS) scores through a series of survey questions concerning their physical health and physical function. RESULTS: Twenty-six patients (20 females, 6 males) met inclusion and exclusion criteria. One patient had both ankles repaired separately, therefore 27 ankles were analyzed. Mean age at the time of surgery was 43 years (range 22-63). Preliminary analysis examined the period between surgery and last clinic visit, with a mean of 3.9 months. Mean concurrent repairs was 2.0. There were no intraoperative complications. All patients were compliant with weightbearing protocol. Complications unrelated to device function totaled 29.6% and included cellulitis (18.5%), suture granuloma (7.4%), and tarsal tunnel syndrome (3.7%), which all resolved after proper intervention. Functional complications included recurrent instability in 1 patient (3.7%) at 8.4 months. PROMIS scores are currently being collected and will be compiled by the end of February 2020. CONCLUSION: Preliminary analysis showed a relatively high overall complication rate at 33.3% (n=7), although recurrent instability was reported by 1 patient only (3.7%). The addition of PROMIS scores will be critical in examining longer term functional outcomes in ATFL repair with bioabsorbable suture anchors.