This is Atsushi Ramoto from Sapporo Medical University. The title of my talk is Clinical Results of Arthroscopic Ankle Lateral Ligament Repair with Accelerated Rehabilitation. 20% of the ankles' brains develop CLAI. Surgical treatment is recommended for CLAI patients in whom non-operative therapies fail. Recently, good clinical results after ARR are reported. ARR is a minimally invasive surgery and early return to sports activities can be anticipated, but post-operative cast immobilization and non-weight bearing are needed in many reports. We performed ARR with accelerated rehabilitation, ARR including early weight bearing without immobilization. The purpose of this study was to report the clinical outcomes of ARR with ARR, which actively performs early weight bearing without immobilization. The subjects were 23 ankles of 22 patients who underwent ARR for diagnosis of CLAI. ARR indicated if all of the following four criteria were met. Number one, previous ankle sprain and chief complaint of instability. Number two, instability confirmed by manual investigation or stress X-rays. Number three, no response to over three months of conservative therapy. And number four, persistence of the ATFL on ultrasonography or MRI. This is our surgical technique. A fiber tuck ankle was placed against the proximal FOT. After a micro suture last was inserted percutaneously into the conflict fiber of the ATFL and CFL. The suture was passed through the remaining ATFL and the capsule together and tied. From day three, full weight bearing working with a brace was permitted. And the ankle was immobilized with sprints only at night to prevent plantar flexion for three weeks. Patients were allowed to start jogging at four weeks and the goal of return to sports at eight weeks. Major symptoms, ankle ROM, stress X-ray measurement and the AT value by a capacitance type strain sensor were evaluated. As a clinical score, the JSSF ankle height foot scale and the safe cue were evaluated. Whether patients had been able to return to sports at eight weeks post-operatively was also asked. These results were compared between pre-operatively and a final follow-up by using a paired T-test. 21 ankles of the 20 patients could be followed for at least six months post-operatively. Comorbidities were present in 16 patients. Concord procedures were also performed in 16 patients. Instability and pain disappeared or improved post-operatively in all patients. There was no significant post-operative change in ROM. There were significant improvements in the anterior draw distance, tail tilt angle and AT value post-operatively. JSSF scale improved significantly and the safe cue score improved significantly on all subscales. Complete return to sports was achieved by 75% at eight weeks post-operatively. Discussion. Haraguchi calculated the load on the ATFL during the gait cycle and that was under 10 Newtons. Robotic research using cadavers has shown the increased load on the ATFL during plantar dorsiflexion was under 10 Newtons. These reports suggest that early weight-bearing exercise following ARR without cat's fixation may not impose a major load on the repaired ligament. Conclusion. ARR following ARR resulted in significant improvements in objective assessment of ankle instability and clinical scores. Patients were able to make an early return to sports activities. ARR followed by ARR may be an effective treatment method for athletes.

arthroscopic ankle lateral ligament repair

accelerated rehabilitation

chronic lateral ankle instability

early return to sports activities

athletes