Localizer-Assisted Arthroscopic Anterior Talofibular Ligament and Calcaneus Fibula Ligament Reconstruction for the Treatment of Chronic Lateral Ankle Instability
Authors: Zhao Liangjun , Xu Fang , Lao Shan , Zhao Jingmin , Wei Qingjun 
Published: January 2021

Abstract
Background Anatomic reconstruction has become one of the standard techniques used for the treatment of chronic ankle instability. Although arthroscopic treatment of chronic ankle instability has made remarkable progress in recent years, no comprehensive description of arthroscopic reconstruction of the ankle ligament is available. The purpose of this study is to describe the surgical technique of localizer-assisted arthroscopic anatomical reconstruction of the anterior talofibular ligament and the calcaneus fibular ligament and to evaluate the clinical effect in patients. Method In total, 36 young adults with simple lateral ankle instability were treated with arthroscopic anatomical reconstruction of the anterior talofibular ligament and the calcaneus fibula ligament, including 20 males and 16 females with an average age of 27 years (17-35 years). All patients had more than three ankle sprains in the past two years. Physical examination revealed positive anterior drawer test results of the ankle and/or talus tilt test results. The operation was performed in two steps. First, we found the adjacent area center of the peroneal lateral stop of the talofibular ligament and the calcaneus fibular ligament on the surface of distal fibula, and the skin mark was made. The localizer guided the surgeon to the location, and then the fibula bone canal was created. Next, the residual end of the talofibular side stop of the anterior fibula ligament was located under the arthroscope, and the talofibular end bone canal was made after the localizer was accurately positioned. Then, the calcaneus lateral stop of calcaneus fibula ligament was located on the calcaneus body surface, and the skin mark was made. Furthermore, the calcaneus end bone canal was generated under guidance of the localizer. Finally, anatomical reconstruction of the anterior talofibular ligament and/or calcaneus fibula ligament was completed in a step-by-step manner. The clinical characteristics, preoperative and postoperative the American Orthopaedic Foot and Ankle Society (AOFAS) and Karlsson scores were recorded. Results The AOFAS score increased from 60 (45-70) to 92 (80-98), and the Karlsson score increased from 62 (40-72) to 95 (75-96) after the operation. During the follow-up period, no patients experienced postoperative complications, such as infection at the incision, nerve injury, skin necrosis and ankle stiffness. No cases of recurrence of ankle instability were found. Conclusion Arthroscopic reconstruction of the talofibular and calcaneus fibular ligaments can achieve satisfactory clinical results in the treatment of chronic ankle instability with lower recurrence rates and reduced complications compared with open surgery. Meanwhile, localizer-assisted reconstruction is a reliable and simple operation technology with high clinical success rates. In addition, increased understanding of anatomic markers is very important to avoid operation failure.