Efficacy of Inferior Extensor Retinaculum Reinforcement in Arthroscopic Ankle Lateral Ligament Repair: A Prospective Randomized Study

Abstract

Background:

Recent advancements in all-inside arthroscopic techniques for chronic ankle instability have shown promising outcomes. However, the necessity and clinical benefits of inferior extensor retinaculum (IER) reinforcement in arthroscopic lateral ligament complex (LLC) repair remain unclear.

Purpose:

To evaluate whether IER reinforcement in arthroscopic LLC repair improves clinical, radiologic, and functional outcomes as compared with isolated arthroscopic LLC repair without IER reinforcement.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

In this study, 59 patients who underwent arthroscopic surgery for chronic ankle instability were prospectively randomized into 2 groups: arthroscopic anterior talofibular ligament repair with (group W, n = 29) and without (group WO, n = 30) IER reinforcement. The primary outcome was the Foot and Ankle Outcome Score at the final follow-up. The visual analog scale for pain, American Orthopedic Foot & Ankle Society score, and Karlsson ankle function score were measured as subjective outcomes. Posturographic analysis, as an objective outcome, was performed with a Tetrax device. Radiologic outcome evaluations were performed preoperatively and 2 years postoperatively using stress radiographs and magnetic resonance imaging in axial view. Complications, including retears, neuralgia, and knot irritations, were recorded.

Results:

No significant differences were found between groups in clinical, proprioceptive, or radiologic outcomes at the final follow-up. Three retears (5.1%) were identified on postoperative MRI (group W, 3.4% [1/29]; group WO, 6.7% [2/30]; P = .580). Complications included knot irritation in 3 patients (10.3%) of group W and superficial peroneal nerve neuralgia in 1 patient (3.3%) of group WO. No significant differences in complications were observed between the groups.

Conclusion:

Arthroscopic LLC repair yields favorable clinical outcomes, regardless of whether IER reinforcement is performed. Given the lack of additional clinical benefit, routine IER reinforcement may not be warranted.

Registration:

Clinical Research Information Services (CRIS), Korea — Registration No.: [KCT0004755].