Endoscopic lateral ligament repair associated with calcaneous osteotomy

Abstract

Objective: Restore lateral ankle stability and correct the underlying inframalleolar varus deformity. Methods: The study was performed on 15 consecutive patients (15 ankles) with chronic lateral ankle instability and cavovarus deformity who underwent endoscopic lateral ankle ligament repair using an 4,5mm knotless anchor (Smith & Nephew Plc) and a Dwyer and sliding calcaneal osteotomy throught a lateral approach fixed with a calcaneus stape plate (Arthrex Inc., Naples, FL, USA) from 2013 to 2015.Patients provided informed consent and then they were invited to a final control follow-up office visit for a detailed evaluation performed for an independent observer using the visual analogue scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS) ankle questionnaire and the evaluation of pre and post X ray Saltzman’s incidences in all patients before and after surgery and during follow-ups. Results: Between February 2013 and November 2015, a lateral sliding osteotomy with a lateral based wedge was performed in 11 patients with a mean age of 38.7±14.6 years (range 21.5-63.4 years). All patients had a history of severe lateral ankle instability associated with a severe inframalleolar cavovarus deformity. Significant pain relief was observed from 7.1±1.8 (range 5-10) to 1.4±1.2 (range 0-4) using the visual analogue scale. The American Orthopedic Foot and Ankle Society’s score improved significantly from 36.9±12.9 (range 10-60) to 88.0±10.5 (range 70-95). Conclusions: Endoscopic ankle ligament repair associated with calcaneal sliding osteotomy and a lateral based wedge may be an effective surgical option for severe chronic ankle instability associated with calcaneous varus deformity. Correcting alignment, restoring stability and reducing pain allows patients to walk and run properly resulting in higher quality of life.