Minimally Invasive Reconstruction of the Ankle Lateral Ligament Complex in Chronic Ankle Instability: Clinical Outcomes, Return to Sport and Recurrence Rate at Minimum Follow up of 5 Years

Background: Chronic ankle instability is a common condition that develops after lateral ankle sprains. Many surgical techniques have been described in case of failure of conservative treatment. The purpose of this paper is to present the results in terms of clinical outcomes, return to sport and recurrence rate after reconstruction of the lateral ligament complex of the ankle with a minimally invasive approach at a minimum follow up of five years. Methods: This retrospective study involved forty-seven patients treated for chronic ankle instability from January 2013 to November 2017. The clinical outcomes were evaluated with the American Orthopedic Foot and Ankle Society ankle and hindfoot score (AOFAS score), the University of California-Los Angeles Rating Scale (UCLA Rating Scale), the Karlsson-Peterson ankle instability score and the Halasi scale at a mean follow up time of 80 months. Results: The mean age of the patients was 42 years (23-63). The mean VAS pain score decreased from 5.6 (2-9) pre-operatively to 0.7 (0-7) post-operatively. The mean UCLA Rating Scale score improved from 7.7 (4-8) before surgical treatment to 9.2 (6-10) afterwards. The AOFAS score increased from a pre-operative mean value of 66.5 (40-95) to a post-operative mean value of 94 (88-100) and the Halasi scale from a pre-injury mean value of 4.3 (2-8) to 4.5 post-operatively (2-8). The mean Karlsson-Peterson ankle instability score increased from 71 (40-90) pre-operatively to 87.9 (70-90) post-operatively. During this period of follow up, the procedure survival rate was 95.7%, with two cases of recurrence of ankle sprain post-operatively after twelve months in one case and forty months in the other case. Conclusions: The described technique of reconstruction of the anterior talofibular and calcaneofibular ligament with a minimally invasive approach with a semitendinosus autograft is a viable treatment option for chronic ankle instability and enables the majority of patients to regain their activity and sport level with a low recurrence rate at a mid-term follow up.