Reconstruction of lateral ligament with arthroscopic drilling for treatment of early-stage osteoarthritis in unstable ankles.

PURPOSE: The purpose of this study was to investigate the clinical, radiologic, and arthroscopic results of lateral stabilization with reconstruction of the lateral ligaments and cartilage regeneration with arthroscopic drilling for the treatment of moderate osteoarthritis of the ankle with simultaneous lateral instability of the ankle (LIA).

METHODS: There were 16 cases with LIA, 7 of which had stage 2 osteoarthritis of the ankle according to the radiographic classification of Takakura et al. and 9 of which had stage 3 osteoarthritis. Arthroscopic drilling was performed with a motorized drill for the chondral defect, and anatomic reconstruction of the lateral ligament with an autologous gracilis tendon graft was performed for LIA. Clinical, radiologic, and arthroscopic evaluations were performed before surgery and at the most recent follow-up.

RESULTS: In stage 2 cases the mean score on the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 42.5 +/- 6.8 points before surgery and 87.4 +/- 4.2 points at the most recent follow-up (P = .0002). In stage 3 cases the mean score was 41.4 +/- 8.0 points before surgery and 61.2 +/- 7.4 points at the most recent follow-up (P = .0001). The talar tilt angles on standard stress radiography in stage 2 cases were 17.4 degrees +/- 4.5 degrees before surgery and 3.4 degrees +/- 0.9 degrees at the most recent follow-up (P = .0009). In stage 3 cases the mean talar tilt angles were 18.2 degrees +/- 4.7 degrees before surgery and 3.6 degrees +/- 0.7 degrees at the most recent follow-up (P < .0001). In all cases the radiographic classification of Takakura et al. was unchanged between assessments before surgery and at the most recent follow-up. With regard to arthroscopic findings at 1 year after surgery, the International Cartilage Repair Society's cartilage repair assessment score showed 6 nearly normal and 1 abnormal stage 2 cases and 1 abnormal and 8 severely abnormal stage 3 cases.

CONCLUSIONS: Reconstruction of the lateral ligament with arthroscopic drilling as a surgical procedure for the treatment of stage 2 osteoarthritis with LIA can be recommended.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.