Reoperation rates following ankle ligament procedures performed with and without concomitant arthroscopic procedures.
OBJECTIVE
Over 50 % of the patients with chronic lateral ankle instability present with some degree of intra-articular pathology. To date, no consensus regarding the concomitant ankle arthroscopy procedures along with ankle ligament procedures has been reached. The purpose of current study was to investigate reoperation rates and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures.


METHODS
Reoperations and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures were investigated using the PearlDiver Patient Record Database (PearlDiver Technologies, Inc.; Fort Wayne, IN, USA) between 2007 and 2011. Ankle ligament procedures, including ligament repair and reconstruction, and ankle arthroscopic procedures were investigated as primary surgery. Subsequently, the reoperation procedures, including ankle ligament procedures, arthroscopic procedures, autologous osteochondral transplantation, and ankle arthrodesis, as well as wound complications and nerve injury following primary ankle ligament procedures were identified.


RESULTS
In 8014 patients receiving ligament repair, the arthroscopic group had a significantly higher reoperation rate in comparison with the non-arthroscopic group (8.8 vs. 6.5 %, odds ratio: 1.1, [p < 0.01], 95 % confidence interval (CI) 1.2-1.7). However, the non-arthroscopic group included 29 open arthrodesis procedures following the primary surgery, whereas arthroscopic group had none. Of the 8055 patients who received a ligament reconstruction, there was no significant difference in reoperation rate between the groups (5.9 vs. 5.9 %, odds ratio: 1.0, [n.s], 95 % CI 0.8-1.2). As seen in the ligament repair group, the non-arthroscopic group had a 4.9 % rate of ankle arthrodesis as a secondary procedure. Arthroscopic group had a significantly lower rate of wound dehiscence following ankle ligament procedures than non-arthroscopic group.


CONCLUSIONS
Concomitant ankle arthroscopy procedures performed with ankle ligament procedures did not decrease the rate of reoperation. However, there was a lower incidence of ankle arthrodesis and a lower rate of wound complications in the arthroscopic group when compared to those in non-arthroscopic group. Based on the results of the study, which analysed 16.069 patients, concomitant ankle arthroscopy is recommended.


METHODS
IV.
Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.|Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Youichi
Y
Yasui
Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.|University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Christopher D
CD
Murawski
Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.|University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Adi
A
Wollstein
Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA. kennedyj@HSS.EDU.
John G
JG
Kennedy
D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D001182:Arthroscopy / Q000009:adverse effects; D016025:Bone Transplantation; D002356:Cartilage / Q000637:transplantation; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D014182:Transplantation, Autologous; D055815:Young Adult
Arthroscopy; Chronic ankle instability; Ligament reconstruction; Ligament repair; Postoperative complications; Surgery