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There is increasing interest in arthroscopic techniques to surgically correct chronic lateral ankle ligament instability.
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The anatomic “safe zone” in the lateral ankle allows surgeons to perform arthroscopic techniques safely.
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Recent published clinical and biomechanical studies show arthroscopic lateral ankle ligament reconstruction to have results similar to open modified Brostrom techniques.
Ankle Instability and Arthroscopic Lateral Ligament Repair
Section snippets
Key points
Anatomy and biomechanics
Understanding the anatomy of the lateral ligamentous complex is essential to the diagnosis and treatment of ankle instability. When considering arthroscopic lateral ligament repair it is equally important to have proper anatomic knowledge of the structures surrounding this complex. To simplify this section, the authors first discuss the basic ligament anatomy and its relation to lateral ankle instability, and then describe the anatomy as it relates to the arthroscopic ligament repair.
Clinical results
Most lateral ligament injuries can be treated nonsurgically, but up to 20% of patients will develop chronic recurrent instability resulting from sensory-motor deficits or insufficient healing of the lateral ligament complex.1, 3, 4, 37, 38, 39 Operative treatment is indicated for those patients with a history of multiple inversion events and continued episodes of instability despite conservative treatment.39 The open modified Brostrom-Gould anatomic repair has been widely accepted as the
ArthroBrostrom intraoperative technique
Although there are several different published arthroscopic techniques for lateral ankle ligament reconstruction, this review discusses the technique the authors helped develop, which has proven biomechanical equivalency to the open Brostrom-Gould procedure.
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Anesthesia: Most patients can have a regional popliteal block plus monitored anesthesia care (MAC). Some patients may require a general anesthesia. If a regional popliteal block is performed, the surgeon or anesthesiologist usually must
Summary
The goal of any arthroscopic procedure is to replace traditional open techniques while obtaining results that are at least equivalent, if not better, than current operative techniques and patient outcomes. Shoulder and knee orthopedic specialists have successfully converted to arthroscopic techniques to deal with most chronic instability patients; however, foot and ankle orthopedists have been previously reluctant to move in the same direction. Multiple studies that reveal both clinical and
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Dr. Jorge I. Acevedo and Dr. Peter Mangone are the consultants for Arthrex Inc.