Chronic lateral instability: Arthroscopic findings and long-term results

Background: A wide variety of procedures have been described to treat chronic lateral ankle instability. Nonanatomic procedures sacrifice normal tissue and can restrict motion. Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments, supplemented by reefing of the exstensor retinaculum (modified Brostrom procedure) provides good long-term stability with minimal drawbacks. Methods: Twenty-one patients had arthroscopic evaluation followed by the Gould modification of the Brostrom procedure. All patients filled out a detailed questionnaire, including the American Orthopaedic Foot and Ankle Society Ankle/Hindfoot Score, Modified Weber Score, and Hamilton Score at an average of 60 months after surgery. All patients were re-examined, and 14 had stress radiographs for comparison with the preoperative films. Results: Ninety-five percent of the patients (20 of 21) had associated intra-articular problems. The mean score for the Modified Weber Score was 96; for the Ankle/Hindfoot Score, 97; and for the Hamilton score, 100% good and excellent results. All 14 patients recorded a side-to-side difference of less than 3 degrees on their postoperative stress radiographs. Conclusions: A high percentage of patients with lateral ankle instability have intra-articular pathology. Excellent results can be expected in patients with ankle instability who undergo arthroscopic treatment of associated intra-articular pathology and the modified Brostrom procedure.