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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2020

01-01-2020 | Arthroscopy | ANKLE

Arthroscopic all-inside ATiFL’s distal fascicle transfer for ATFL’s superior fascicle reconstruction or biological augmentation of lateral ligament repair

Authors: Jordi Vega, Daniel Poggio, Nasser Heyrani, Francesc Malagelada, Matteo Guelfi, Aida Sarcon, Miki Dalmau-Pastor

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2020

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Abstract

Purpose

Tendon grafts are often utilized for reconstruction of the lateral ligaments unamenable to primary repair. However, tendon and ligaments have different biological roles. The anterior tibiofibular ligament’s (ATiFL) distal fascicle may be resected without compromising the stability of the ankle joint. The aim of this study is to describe an all-arthroscopic and intra-articular surgical technique of ATiFL’s distal fascicle transfer for the treatment of chronic ankle instability.

Methods

Five unpaired cadaver ankles underwent arthroscopic ATiFL’s distal fascicle transfer using a non-absorbable suture and a knotless anchor. Injured or absent ATiFL’s distal fascicle were excluded from the study. Following arthroscopy, the ankles were dissected and evaluated for entrapment of nearby adjacent anatomical structures. The ligament transfer was also assessed. The distance between the anterolateral (AL) portals and the superficial peroneal nerve (SPN) was measured and the shortest distance was reported.

Results

All specimens revealed successful transfer of the tibial origin of the ATiFL’s distal fascicle onto the talar insertion of anterior talofibular ligament’s (ATFL) superior fascicle. The fibular origin of the ATiFL’s distal fascicle remained intact. There were no specimens with SPN or extensor tendon entrapment. The median distance between the proximal AL portal and SPN was 3.8 mm. The median distance between the distal AL portal and SPN was 3.9 mm.

Conclusion

An all-arthroscopic approach to an ATiFL’s distal fascicle transfer is a reliable method to reconstruct the ATFL’s superior fascicle. Transfer of ATiFL’s distal fascicle avoids the need for tendon harvest or allograft. The lack of injury to nearby adjacent structures suggests that it is a safe procedure. The clinical relevance of the study is that ATiFL’s distal fascicle can be arthroscopically transferred to be used as a biological reinforcement of the ATFL repair, or as an ATFL reconstruction.
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Metadata
Title
Arthroscopic all-inside ATiFL’s distal fascicle transfer for ATFL’s superior fascicle reconstruction or biological augmentation of lateral ligament repair
Authors
Jordi Vega
Daniel Poggio
Nasser Heyrani
Francesc Malagelada
Matteo Guelfi
Aida Sarcon
Miki Dalmau-Pastor
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05460-z

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