Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability: Case Series
Condition: Ankle Injuries; Ligament Injury; Joint Instability; Deltoid Ligament; Sprain (Strain) (Ankle); Talofibular Ligament Tear
MeSH terms: Joint Instability; Wounds and Injuries; Ankle Injuries; Sprains and Strains
Study type: Observational

Summary: 
      Abstract Introduction: The high prevalence of sprains in the population has provided a
      substantial number of patients with lateral instability of the ankle. The continuity of this
      condition can lead to the progressive loosening of the medial containment structures,
      generating a multidirectional rotational instability. The deltoid approach through the
      imbrication of its components has been proposed as a solution for these patients. The
      arthroscopic technique has been described as an alternative.

      Methods: This is a retrospective study with patients diagnosed with multidirectional
      instability and submitted to an ankle arthroscopy with medial repair (arthroscopic
      tensioning) and lateral (arthroscopic Brostrom) between January 2018 and January 2020. All
      patients will fill an epidemiological questionnaire and will be evaluated for pain and
      function according to the Visual Analogue Scale (VAS) and the American Orthopaedic Foot and
      Ankle Society Score (AOFAS) at 12 months (6-24 months) average of follow-up.

      Discussion: The combined medial and lateral arthroscopic repair may be an effective and safe
      alternative in the treatment of multidirectional instability. The inclusion of the deltoid
      complex and the low invasiveness of this technique can improve the clinical outcomes of these
      patients. Additional studies, with a prospective and comparative methodology are required to
      sustain this proposal.

      Design: Level IV. Retrospective case series.

      Keywords: ankle injuries; lateral ligament; collateral ligaments; joint instability
    


Intervention name(s): Arthroscopic Brostrom combined with Arthroscopic Deltoid Repair
Intervention type(s): Procedure
Intervention description(s): After anesthesia and surgical site preparation, traditional arthroscopic portals were performed. A 4.5mm set was used to clean the joint and assess possible associated injuries. Anterolateral and anteromedial impacts were resected when needed. Lateral and medial instability were confirmed arthroscopically, and ligament repairs prepared, starting by the lateral compartment. A traditional Arthroscopic Brostrom was performed, using one anchor and suture passers. Sutures are passed but not tightened. Medial anchor insertion is executed at the medial malleolus, in the quadrant described by Vega et al. Sutures were passed respecting the safe zone illustrated by Acevedo at al. The ankle was positioned in neutral (no posterior drawer) and the lateral sutures tightened with arthroscopic knots. Finally, the medial repair is finalized by tightening the deltoid sutures with the ankle at the same position. Portals were closed and a dressing applied.
Observational model: Case-Only
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Tertiary teaching hospital patients, athletes and non-athletes.