Clinical Application of 3D Printing in Non-Arthroscopic Ankle Ligament Reconstruction: A Single-Center Retrospective Study.

Abstract

Chronic lateral ankle instability (CLAI) often requires anatomic ligament reconstruction after failed conservative treatment. Precise bone tunnel placement remains challenging during traditional open surgery. To evaluate the clinical value of three-dimensional (3D) printed personalized guide plates for improving surgical precision and reducing intraoperative radiation exposure during lateral ankle ligament reconstruction. Retrospective comparative cohort study. Forty-eight patients with CLAI were consecutively enrolled and allocated by surgery date to a template group (n = 24) or a conventional group (n = 24). Primary outcomes included operation time, intraoperative fluoroscopy frequency, and radiation exposure time. Secondary outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) score, Visual Analog Scale (VAS), and Karlsson score. The VAS, which measures patient-reported pain intensity on a 10-cm line, was completed independently without surgeon interference. Clinical stability was assessed using the Anterior Drawer and Talar Tilt tests. All patients completed 12-20 months of follow-up (mean, 14.5 ± 5.5 months). Compared with the conventional group, the template group had a shorter operation time (35.42 ± 5.23 vs. 44.79 ± 6.85 min, p < 0.001) and fewer fluoroscopic exposures (1.58 ± 0.65 vs. 3.33 ± 0.48, p < 0.001). No significant between-group differences were observed in AOFAS, VAS, or Karlsson scores at the final follow-up (all p > 0.05). Both groups had negative Anterior Drawer and Talar Tilt tests postoperatively, indicating successful stabilization. Compared with conventional surgery, 3D-printed guide-assisted surgery significantly reduced operation time, intraoperative positioning time, and radiation exposure. It is a promising and efficient approach for non-arthroscopic ankle ligament reconstruction. 3.