Two-year clinical outcome of ultrasound-guided repair of the anterior talofibular ligament with or without Gould augmentation: A case series.

Abstract

Building on the prior work, the authors have shown that ultrasound-guided anterior talofibular ligament (ATFL) repair with augmentation enables precise anchor placement, restores ankle stability in cadaveric models, and improves six-month clinical outcomes. The objective of the current study is to assess the mid-term clinical outcomes of this procedure over a two-year period. The authors treated patients with chronic lateral ankle instability using intraoperative ultrasound-guided ATFL repair, with or without Gould augmentation, followed by a standardized postoperative rehabilitation protocol. After excluding 21 patients with concomitant injuries that could affect clinical outcomes and 8 patients who were lost to follow-up, 20 patients (10 athletes and 10 nonathletes) were included in the study. The following outcome scores were measured at baseline and at two years postoperatively: (1) numerical rating scale (NRS) for pain, (2) foot and ankle outcome score (FAOS), (3) Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale, and (4) self-administered foot evaluation questionnaire sports (SAFE-Q Sports) score. All four clinical outcome measures improved statistically significantly at two years (all p ​< ​0.001). Values are reported as median interquartile range (IQR); effect sizes as standardized mean differences (SMD). Median NRS decreased from 4.0 (2.0-5.0) at baseline to 0.0 (0.0-1.0) at two years (Wilcoxon signed-rank test, p ​< ​0.001; SMD ​= ​1.545). FAOS increased from 76.5 (66.2-80.3) to 99.5 (96.5-100.0) (p ​< ​0.001; SMD ​= ​2.046). JSSF scale increased from 59.5 (44.0-67.0) to 100.0 (90.0-100.0) (p ​< ​0.001; SMD ​= ​2.834). Among athletes with available data, SAFE-Q Sports score increased from 38.8 (21.5-51.0) to 99.0 (96.7-99.9) at two years (p ​< ​0.001; SMD ​= ​3.262). Ten athletes returned to sports at their pre-injury level by six months. Complications were limited to one case of superficial peroneal nerve irritation, which resolved within six months. One patient underwent revision surgery at two years. For chronic lateral ankle instability, ultrasound-guided ATFL repair-with or without augmentation-produced statistically significant improvements at two years (all p ​< ​0.001). Ⅳ.