The arthroscopic all-inside ankle lateral collateral ligament repair is a safe and reproducible technique

Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):63-69. doi: 10.1007/s00167-019-05427-0. Epub 2019 Mar 4.


Purpose: Neurovascular structures around the ankle are at risk of injury during arthroscopic all-inside lateral collateral ligament repair for the treatment of chronic ankle instability. This study aimed to evaluate the risk of damage to anatomical structures and reproducibility of the technique amongst surgeons with different levels of expertise in the arthroscopic all-inside ligament repair.

Methods: Twelve fresh-frozen ankle specimens were used for the study. Two foot and ankle surgeons with different level of experience in the technique performed the procedure on 6 specimens each. The repair was performed following a standardized procedure as originally described. Then, an experienced anatomist dissected all the specimens to evaluate the outcome of the ligament repair, any injuries to anatomical structures and the distance between arthroscopic portals and the superficial peroneal nerve (SPN) and sural nerve.

Results: Dissections revealed no injury to the nerves assessed. Mean distance from the anterolateral portal and the SPN was of 4.8 (range 0.0-10.4) mm. The mean distance from the accessory anterolateral portal to the SPN and sural nerve was of 14.2 (range 7.1-32.9) mm and 28.1 (range 2.8-39.6) mm, respectively. The difference between the 2 surgeons' groups was non-statistically significant for any measurement (mm). In all specimens both fascicles of the anterior talofibular ligament were reattached onto its original fibular footprint. The calcaneofibular ligament was not penetrated in any specimen.

Conclusions: The all-inside arthroscopic lateral collateral ligament repair is a safe and reproducible technique. The clinical relevance of this study is that this technique provides a safe and anatomic reattachment of the anterior talofibular ligament, with minimal risk of injury to surrounding anatomical structures regardless of the level of experience with the technique.

Keywords: Anatomy; Ankle arthroscopy; Chronic ankle instability; Learning curve; Ligament repair.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ankle Injuries / complications
  • Ankle Injuries / surgery*
  • Ankle Joint / anatomy & histology
  • Ankle Joint / surgery*
  • Arthroplasty / adverse effects
  • Arthroplasty / methods*
  • Arthroscopy / adverse effects
  • Arthroscopy / methods
  • Cadaver
  • Chronic Disease
  • Dissection
  • Female
  • Humans
  • Joint Instability / etiology
  • Joint Instability / surgery
  • Lateral Ligament, Ankle / anatomy & histology
  • Lateral Ligament, Ankle / surgery*
  • Male
  • Middle Aged
  • Peripheral Nerve Injuries / diagnosis*
  • Peripheral Nerve Injuries / prevention & control*
  • Peroneal Nerve / anatomy & histology
  • Peroneal Nerve / injuries
  • Peroneal Nerve / surgery
  • Reproducibility of Results
  • Sural Nerve / anatomy & histology
  • Sural Nerve / injuries
  • Sural Nerve / surgery