ARTHROSCOPIC TREATMENT FOR IMPINGEMENT OF THE ANTEROLATERAL SOFT TISSUES OF THE ANKLE (Comparison Between The Patients With or Without Ankle Instability)

Abstract

Objective: To evaluate the outcome of the arthroscopic treatment of the anterolateral soft tissue impingement (ALSTI) of the ankle in patients with or without ankle instability.
Patients and methods: We treated 19 patients who had ALSTI of their 19 ankles by arthroscopic debridement. All had a history of single or multiple inversion injuries, followed by chronic pain over the anterolateral aspect of the ankle. There were 8 male and 11 female patients. The patients were classified into two groups according to the instability findings in physical examination. There were 9 patients who had ALSTI associated with ankle instability (Group 1) and 10 patients who had only ALSTI without ankle instability (Group 2). Arthroscopic debridement was performed of the impingement of anterolateral soft-tissue in all. And if present, an abnormally thickened distal fascicle of the anteroinferior tibiofibular ligament that was in contact with talus during dorsiflexion was also excised. Additionally, in group 1, an anatomic repair of the anterolateral talofibular ligament was done in 6 patients and reconstruction of the lateral ligament complex by Chrisman-Snook technique in the other 3 patients. The outcome was evaluated by the American Orthopaedic Foot & Ankle Society score (AOFAS). The period for returning to previous level of activitiy was also recorded.
Results: The average age of the patients was 28 years (range, 16-50) and the average follow-up was 50 months (range, 10-96). The average preoperative AOFAS score of 67 points (65 to 73) improved to 88 points (76 to 95) in Group 1. Seven ankles were rated as excellent or good and 2 others as fair. Six patients returned to their previous level of physical activity at an average of 15 weeks. In Group 2, the average preoperative AOFAS score of 63 points (39 to 73) improved to 93 points (87 to 100) at the last follow-up. All of the ankles were rated excellent or good. Eight patients returned to previous activities at an average of 7 weeks. No difference was found between two groups in terms of postoperative AOFAS score (p>0.05). However, the period for returning to the previous activity level was significantly shorter in group 2 than in group 1 (p<0.05).
Discussion: With additional ligament repair or reconstruction, the anterolateral soft-tissue impingement of the ankle can be successfully treated by ankle arthroscopy even in cases with ankle instability. However, the period for returning to the previous activity level was significantly longer in patients with associated ankle instability.