Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability

Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):132-140. doi: 10.1007/s00167-017-4736-y. Epub 2017 Oct 5.


Purpose: When the anterior fascicle of the deltoid ligament is injured in patients with chronic ankle instability, the diagnosis of rotational ankle instability is supported. The aim of this study was to report the results of an all-arthroscopic technique to concomitantly repair the lateral collateral and deltoid ligaments to treat patients with rotational ankle instability.

Methods: Thirteen patients [12 men and 1 woman, median age 32 (15-54) years] with rotational ankle instability were treated by arthroscopic means after failing non-operative management. Median follow-up was 35 (18-42) months. Using a suture passer and knotless anchors, the ligaments were repaired with an arthroscopic all-inside technique.

Results: During diagnostic arthroscopy, 12 patients showed an isolated anterior talofibular ligament (ATFL) injury, and in one patient, both the ATFL and calcaneofibular ligament were affected. Arthroscopic examination of the deltoid ligament demonstrated a tear affecting the anterior area of the ligament in all cases. The tear was described as an "open book" tear, because the ligament was separated from the medial malleolus when applying passive internal rotation of the tibio-talar joint. This gap was closed when the tibio-talar joint was in neutral rotation or externally rotated. All patients reported subjective improvement in their ankle instability after the arthroscopic all-inside ligaments repair. The median AOFAS score increased from 70 (44-77) preoperatively to 100 (77-100) at final follow-up.

Conclusion: Rotational ankle instability can be successfully treated by an arthroscopic all-inside repair of the lateral and medial ligaments of the ankle.

Level of evidence: Level IV, retrospective case series.

Keywords: Ankle arthroscopy; Ankle instability; Deltoid ligament; Rotational instability; Treatment.

MeSH terms

  • Adolescent
  • Adult
  • Ankle
  • Ankle Injuries / surgery
  • Ankle Joint / surgery*
  • Arthroscopy / methods*
  • Female
  • Humans
  • Joint Instability / surgery
  • Lateral Ligament, Ankle / injuries
  • Lateral Ligament, Ankle / surgery*
  • Ligaments, Articular / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rotation
  • Sprains and Strains / surgery
  • Suture Anchors
  • Suture Techniques
  • Treatment Outcome
  • Young Adult