Clinical Study Of All-inside Arthroscopic Reconstruction Of Anterior Talo-fibular Ligament Using Socket-anchor Technique

Objective To explore a new method of arthroscopic bone tunnel drilling and graft fixation--Socket-Anchor technique to reconstruct the anterior talofibular ligament for the treatment of chronic ankle instability.Visual analogue scale(VAS)of pain,American Orthopaedic Foot and Ankle Society(AOFAS)score,and Tegner score,MRI and complications were recorded to evaluate the clinical outcome and the feasibility and safety of this technique.Methods Twenty patientswith chronic lateral ankle instability[18 males,2females;aged 30.3 ± 4.64 years(range of 20-38)and treated between January 2017 and June 2018 were analyzed retrospectively.All patients were diagnosed as the anterior talofibular ligament structure missing.Posterior foot deformity,ankle osteoarthritis,talar-tilt Angle>9° with calcanofibular ligament injury,subtalar joint instability,and Patients with age >40 years old and low activity requirements were excluded.All patients were performed all-arthroscopy ATFL reconstruction,talus side uses the Socket-anchor technology,namely drilling 10 mm long,6 mm diameter of bone tunnel in the the ATFL talar footprint,but bone tunnel without throughout the entire talus--blind tunnel,at the end of the blind tunnel insert into a suture anchor.Suture anchor is used as pulley to introduce the tendon graft and knot and fix the tendon graft in bone graft.The operation was completed through 3 protal.One week before the operation and one year after the operation,all patients were evaluated using the Visual Analogue Score(VAS),American Orthopedic Foot and Ankle Surgery Association(AOFAS)score and Tegner score,and their complications were also recorded.Results The average follow-up time of the 20 patients was 21.3 ± 5.28 months(12~30 months).The average preoperative VAS score was 2.9 ± 0.55,significantly higher than the average postoperative one,0.4 ± 0.5.The average AOFAS was 73.55±7.52 before the operation,significantly lower than that after the operation,96.45 ±4.96(P<0.05).The average Tegner score increased significantly from 2.6 ± 0.82 to6.35 ± 0.67 after the surgery(P<0.05)One patient had mild ankle stiffness,but no patients were found serious complications such as re-rupture of ligament and nerve injury.Postoperative 3D-CT examination showed that the bone tunnel was in correct position.The MRI results 12 months after surgery showed normal gray intensity and good tension of the reconstructed ATFL ligamentsConclusion We discussed a new technique for bone tunnel drilling and graft fixation of the talar footprint in ATFL reconstruction,named Socket-Anchor technique,which is a combination of suture anchor and bone tunnel.This method not only is beneficial to tendon-bonehealing,but also reduces the risk of complications as much as possible.The application of Socket-Anchor technology has achieved a good clinical outcome.Although the follow-up time was limited,it also proved to be a feasible,safe and minimally invasive surgical procedure.