Preoperative predictors of arthroscopically confirmed lateral ankle micro-instability and two-year outcomes after arthroscopic repair of the ATFL superior fascicle

Shi-Ming Feng; Chong Xue; Chang-Qing Shao; Chao-Fan Su; Shun-Hong Gao

doi:10.1016/j.fas.2026.07.009

Preoperative predictors of arthroscopically confirmed lateral ankle micro-instability and two-year outcomes after arthroscopic repair of the ATFL superior fascicle

Foot Ankle Surg. 2026 Jul 15:S1268-7731(26)00203-1. doi: 10.1016/j.fas.2026.07.009. Online ahead of print.

Authors

Shi-Ming Feng¹, Chong Xue², Chang-Qing Shao², Chao-Fan Su², Shun-Hong Gao³

Affiliations

¹ Sports Medicine Department, Xuzhou Central Hospital, Southeast University, Xuzhou, Jiangsu 221009, China. Electronic address: fengshiming_04@163.com.
² Sports Medicine Department, Xuzhou Central Hospital, Southeast University, Xuzhou, Jiangsu 221009, China.
³ Orthopaedic Department, The Second Hospital of Tangshan, Tangshan, Hebei 063000, China.

PMID: 42463367
DOI: 10.1016/j.fas.2026.07.009

Abstract

Background: Lateral ankle microinstability (LAM) caused by anterior talofibular ligament (ATFL) superior fascicle injury is difficult to diagnose preoperatively.

Methods: Sixty-seven patients with suspected LAM underwent arthroscopy. Preoperative anterior talar translation (ATT), active joint position sense (AJPS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Karlsson Ankle Functional Score (KAFS) were compared between LAM and non-LAM groups. Logistic regression and Receiver operating characteristic analysis identified predictors. Confirmed LAM cases underwent arthroscopic superior fascicle repair and were followed for 2 years.

Results: Forty-five patients had confirmed LAM. ATT and AJPS errors were significantly greater in the LAM group. ATT and AJPS error at 10° plantar flexion were independent predictors. The combined model showed excellent discrimination (AUC, 0.90). At 2 years, ATT, AJPS, AOFAS, and KAFS improved significantly after arthroscopic repair procedure.

Conclusions: Combined assessment of ATT and AJPS improves preoperative prediction of LAM. Arthroscopic ATFL superior fascicle repair was associated with improved stability, proprioception, and function.

Level of evidence: Level III.

Keywords: Active joint position sense; Anterior talar translation; Anterior talofibular superior fascicle repair; Lateral ankle microinstability.