Arthroscopic Lateral Ligament Repair

Ankle sprain is one of the most common sports-related injuries and involves the three ligaments of the lateral ligament complex of the ankle. Approximately 80% of patients tear the anterior talo-fibular ligament (ATFL), while the other 20% of patients tear the ATFL and calcaneo-fibular ligament (CFL). Rarely, the posterior talo-fibular ligament (PTFL) is involved. Non-surgical management of ankle sprains leads to excellent results in most cases for the initial phase. An incidence of 10 – 30% of patients would fail conservative treatment and result in chronic lateral ankle instability (CLAI) that may require surgical intervention. And the CLAI is commonly associated with other lesions, such as osteochondral lesion, soft tissue impingement syndrome, loose body, and peroneal tendon disorder so that diagnostic arthroscopy is mandatory with stabilizing lateral ankle. Although more than 50 surgical procedures have been described for stabilizing the lateral ankle ligaments complex. The original technique of Broström, modified by Gould, has become the gold standard procedure with infrequent exception in the literatures. However, the open technique requires at least a 4-cm-long incision with significant dissection and soft tissue debridement. Recently, there has been a recent advent of published descriptions on arthroscopic procedures for CLAI with advanced anatomic and bio-mechanic researches of lateral ankle ligaments complex. As in other minimal invasive surgical techniques in the foot and ankle, arthroscopic lateral ligament repair has advantages of less pain, addressing intra-articular pathologies, less injury to surrounding tissue, faster recovery, shorter hospital stay, and better cosmetic result. However, there are concerns about this new emerging technique with a technically demanding and lack of long-term clinical results. The purpose of this presentation is to review what has been established for the CLAI and discuss the arthroscopic lateral ligament repair technique.