Results of a survey of practices in chronic ankle instability in France

BACKGROUND: After a failed conservative treatment, surgical techniques used to treat chronic ankle instability are being more and more evaluated and proficiency is increasing. - Ligament repairs associated with tissue reinforcement; - Ligament reconstructions more or less in anatomic position. Anatomic techniques have proven to be superior to non-anatomic techniques. These different surgical techniques performed arthroscopically have the main advantage to manage simultaneously associated injuries that are very common in chronic ankle instability. For some, it is the last and best diagnostic test through which a decision can be made between repair and reconstruction. Despite all this knowledge, the indications remain very heterogeneous and essentially depend on surgeons’ preference. The primary objective was of this study was make an accurate assessment of practices in France. The secondary objective was to identify situations in which the choice of surgical treatement appeared to be consensual or controversial and to try to identify the parameters that influence these choices. METHODS: A survey of practices was conducted among foot and ankle surgeons in France from 3 different societies (SFA, AFCP, and GRECMIP). The survey consisted of 2 parts; the first part focused on the surgeon’s characteristics and the second part presented 3 clinical cases. A therapeutic choice was validated for each situation. RESULTS: Two hundred and twenty-eight responses were recorded. The average age of surgeons was 46 years and they had been treating ankle instability for an average of 14 years. 67% performed this procedure less than 20 times a year and only 7% more than 50 times. More than half of them adapted to each situation (56%) while 44% always use the same technique. In 9% of cases because they are only proficient in one technique and in the other cases because they believe the technique always provides good results. 63% used the technique in open surgery, 21% under arthroscopy, 13% in minimally invasive surgery and in 7% of the cases an initial arthroscopy is performed before open surgery for stabilization. CONCLUSION: This survey reflected the heterogeneity of surgical practices in ankle instability and provided indications for areas of research in clinical situations with the least consensus.