Endoscopic anatomic ligament reconstruction is a reliable option to treat chronic lateral ankle instability

Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):86-92. doi: 10.1007/s00167-019-05793-9. Epub 2019 Nov 14.


Purpose: Anatomic reconstruction of the anterior talofibular ligament and calcaneofibular ligament is a valid treatment of chronic hindfoot instability. The purpose of this study was to investigate the outcomes of this procedure performed by an all-inside endoscopic technique.

Methods: This study is a retrospective evaluation of a prospective database. Subjects were all patients who underwent an endoscopic lateral ligament reconstruction between 2013 and 2016. All patients had symptoms of ankle instability with positive manual stress testing and failed nonoperative treatment during at least 6 months. At final follow-up the outcome was assessed using the visual analogue score (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Karlsson-Peterson scores.

Results: After an average follow-up of 31.5 ± 6.9 months, all patients reported significant improvement compared to their preoperative status. The preoperative AOFAS score improved from 76.4 ± 15 to 94.7 ± 11.7 postoperatively (p = 0.0001). The preoperative Karlsson-Peterson score increased from 73.0 ± 16.0 to 93.7 ± 10.6 postoperatively (p = 0.0001). The VAS score improved from 1.9 ± 2.5 to 0.8 ± 1.7 (p < 0.001). Two patients had complaints of recurrent instability.

Conclusion: Endoscopic ligament reconstruction for chronic lateral ankle instability is a safe procedure and produces good clinical results with minimal complications. In addition, the endoscopic approach allows an assessment of the ankle joint and treatment of associated intra-articular lesions.

Level of evidence: II.

Keywords: Ankle instability; Ankle ligament; Anterior talofibular ligament; Arthroscopy; Autograft; Calcaneofibular ligament; Endoscopic reconstruction; Ligament reconstruction.

MeSH terms

  • Adult
  • Ankle Injuries / complications
  • Ankle Injuries / surgery*
  • Ankle Joint / surgery
  • Arthroscopy / methods*
  • Female
  • Humans
  • Joint Instability / etiology
  • Joint Instability / surgery*
  • Lateral Ligament, Ankle / injuries
  • Lateral Ligament, Ankle / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sprains and Strains / complications
  • Sprains and Strains / surgery