Hello, my name is Tara Montsman, and I'm a foot and ankle surgeon with the Rothman Institute in Orlando, Florida. Today I will be presenting on the clinical and radiographic outcomes after total ankle arthroplasty and internal brace lateral ankle ligament reconstruction for arthritic ankle instability. My coauthors and I do have some disclosures, however, there was no funding specifically related to this talk. To start, end-stage ankle arthritis with ligamentous instability is common, and correction of this instability is key to having a successful outcome after ankle arthroplasty surgery. To date, there is no current evidence on the use of suture tape to correct residual intraoperative lateral ankle instability in the setting of ankle arthroplasty. The purpose of our study was to evaluate the clinical and radiographic outcomes after surgical correction of the unstable arthritic ankle with an ankle replacement and suture tape lateral ankle ligament reconstruction. This was a retrospective chart review at a single institution looking at primary total ankles with suture tape by three fellowship-trained surgeons. Primary outcome measures included the FAM functional outcome score and the VAS pain score. We also measured pre- and post-operative Taylor tilt in order to determine the amount of coronal deformity correction. This was done at pre-op as well as at one and two years post-operative. Lastly, we looked at complications, including hardware failure, residual or persistent instability, and a need for secondary or revision surgery. Patients were included if they were over 18 years old, had a diagnosis of ankle arthritis with ankle instability, and underwent a primary total ankle arthroplasty with lateral ankle ligament reconstruction using the internal brace only. Patients were excluded if they had revision surgery or if any other method other than the internal brace was used to reconstruct the lateral ligament complex. We had a total of 33 patients. There was no significant difference in comorbidities as well as age, sex, or BMI amongst all patients. There were a total of three complications, two for component loosening and one for a deep infection. Our results demonstrated a significant improvement in FAM and VAS scores from pre-op to each of the post-op intervals at six months, one year, and two years. Our radiographic data also demonstrated significant improvements in coronal plane deformity from pre-op to one year and two years post-operative. The mean pre-operative Taylor-Till angle was 11.9 degrees with a range of 1.4 to 25.7 degrees. The mean post-op Taylor-Till angles were 1.1 degrees at one year and 0.7 degrees at two years. Additionally, there was no significant difference found in angles between the one and two-year mark, inferring that the correction was maintained for up to two years post-operative. In conclusion, combined ankle arthritis and instability can be a really challenging problem for the foot and ankle surgeon. The use of suture tape to reconstruct the lateral ankle ligament complex in the setting of total ankle arthroplasty provides and maintains adequate correction of any residual coronal deformity at final follow-up of at least two years. Thank you.

clinical outcomes

radiographic outcomes

total ankle arthroplasty

internal brace lateral ankle ligament reconstruction

arthritic ankle instability