title: Activity Level and Function 2 Years After Anterior Talofibular Ligament Repair: A Comparison Between Arthroscopic Repair and Open Repair Procedures.
abstract: BACKGROUND
  The open modified Broström anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. Despite recent increases in publications regarding arthroscopic repair of the anterior talofibular ligament (ATFL) for treatment of chronic ankle instability, research is lacking that compares the functional outcomes between arthroscopic repair and open repair procedures for chronic ankle instability.
  
  
  OBJECTIVE
  To compare function and activity level after arthroscopic repair versus open repair of the ATFL in patients with lateral ankle instability.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  All patients who underwent arthroscopic or open surgical Broström repair of the ATFL between January 2012 and August 2014 were invited to participate in this study. All of the patients had consented for arthroscopic repair if feasible. In cases in which arthroscopic repair was impossible, the open modified Broström procedure was performed after arthroscopy. Patients accepted a systematic rehabilitation program postoperatively. American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner activity score were used to evaluate ankle function preoperatively and at a minimum follow-up of 2 years. Magnetic resonance imaging (MRI) was performed to evaluate the signal to noise ratio (SNR) of the repaired ATFL.
  
  
  RESULTS
  A total of 60 patients were included in this study. They were assigned to 1 of 2 groups according to their surgical procedure: 23 patients underwent arthroscopic repair (arthroscopic group) and 37 patients underwent open repair (open group). No patient in either group had ankle instability at follow-up postoperatively. After surgery, the AOFAS score ( P < .001), KAFS ( P < .001), and Tegner activity score ( P < .001) increased significantly in both groups. However, no significant difference was found in AOFAS score (93.3 ± 8.9 vs 92.4 ± 8.6; P = .7), KAFS (90.3 ± 12.5 vs 89.4 ± 10.6; P = .75), and Tegner score (5 ± 2 vs 5 ± 2; P = .61) between the arthroscopic group and the open group, respectively. As well, no significant difference was found in the mean SNR value of ATFL between the arthroscopic group and the open group (9.1 ± 2.7 vs 8.8 ± 2.3; P = .39, respectively).
  
  
  CONCLUSIONS
  When compared with open lateral ankle repair, arthroscopic repair of lateral ankle ligament when feasible produced similarly favorable outcomes. Arthroscopic ATFL repair, as a minimally invasive technique, provided favorable outcomes.
authors.affiliation: Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China.
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Hua
authors.affiliation: Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China.
authors.forename: Hongyun
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China.
authors.forename: Kui
authors.initials: K
authors.lastname: Ma
authors.affiliation: Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China.
authors.forename: Shengkun
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China.
authors.forename: Shiyi
authors.initials: S
authors.lastname: Chen
mesh_terms: D000328:Adult; D016512:Ankle Injuries / Q000503:physiopathology / Q000601:surgery; D000843:Ankle Joint / Q000503:physiopathology / Q000601:surgery; D001182:Arthroscopy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017844:Lateral Ligament, Ankle / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D065466:Lysholm Knee Score; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods*; D011184:Postoperative Period; D055815:Young Adult
keywords: ATFL; MRI; arthroscopic repair; lateral ankle ligaments