Clinical application of 3D printing in non-arthroscopic ankle ligament reconstruction: A single-center retrospective study

BACKGROUND: Chronic lateral ankle instability (CLAI) often requires anatomic ligament reconstruction after failed conservative treatment. Precise bone tunnel placement remains challenging during traditional open surgery. PURPOSE: 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. STUDY DESIGN: Retrospective comparative cohort study. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.