Abstract Background In chronic lateral ankle instability (CLAI) and irreparable anterior talofibular ligament (ATFL), reconstruction procedures are commonly advocated. All-inside arthroscopic capsular plication may be a viable alternative for CLAI in patients with an unrepairable ATFL. Source of data A retrospective study was conducted between 2016 and 2021 on 92 consecutive CLAI patients with arthroscopically confirmed unrepairable ATFL who underwent all-inside arthroscopic surgery. Patients were divided into two groups: in the reconstruction group (n = 40), an autologous gracilis tendon was used to reconstruct the lateral ligament complex; in the plication group (n = 52), the lateral ankle capsule was plicated using a double-loaded suture anchor. Areas of agreement Restoring lateral ankle stability is the optimal goal in the management of CLAI. Areas of controversy The reliability of all-inside arthroscopic capsular plication for CLAI with an irreparable ATFL compared with reconstruction procedures remains uncertain. Growing points Over 2 years of follow-up, the plication group achieved superior American Orthopedic Foot and Ankle Society scores at 3 months and 1 year, and higher Karlsson Ankle Functional scores at 1 and 2 years, whereas the reconstruction group demonstrated better anterior talar translation scores; ankle joint position sense was comparable between groups. Areas timely for developing research Biomechanical comparisons between the two procedures are urgently needed.
Feng et al. (Sat,) studied this question.