A Biomechanical Comparison of 3 Different Arthroscopic Lateral Ankle Stabilization Techniques in 36 Cadaveric Ankles

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Arthroscopic lateral ankle stabilization has become an increasingly popular option among foot and ankle surgeons to address lateral ankle instability, because it combines a modified Broström-Gould procedure with the ability to address any intra-articular pathologic findings at the same session. The present study evaluated 3 different constructs in a cadaveric model. Thirty-six fresh frozen cadaver limbs were used, and the anterior talofibular ligament was identified and sectioned. The specimens were then placed into 1 of 3 groups. Group 1 received a repair with a single-row, 2-suture anchor construct; group 2 received repair with a novel, double-row, 4-anchor knotless construct; and group 3 received repair with a double-row, 3-anchor construct. Specimens were then tested for stiffness and load to ultimate failure using a customized jig. Stiffness was measured in each of the groups and was 12.10 ± 5.43 (range 5.50 to 22.24) N/mm for group 1, 13.40 ± 7.98 (range 6.71 to 36.28) N/mm for group 2, and 12.55 ± 4.00 (range 6.48 to 22.14) N/mm for group 3. No significant differences were found among the 3 groups in terms of stiffness (p = .939, 1-way analysis of variance, a = 0.05). The groups were tested to failure, with observed force measurements of 156.43 ± 30.39 (range 83.69 to 192.00) N for group 1, 206.62 ± 55.62 (range 141.37 to 300.29) N for group 2, and 246.82 ± 82.37 (range 164.26 to 384.93) N for group 3. Statistically significant differences were noted between groups 1 and 3 (p = .006, 1-way analysis of variance, a = 0.05). The results of the present study have shown that a previously reported arthroscopic lateral ankle stabilization procedure, when modified with an additional proximal suture anchor into the fibula, results in a statistically significant increase in strength in terms of the maximum load to failure. Additionally, we have described a previously unreported, knotless technique for arthroscopic lateral ankle stabilization.

Level of Clinical Evidence: 5

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