Comparative effectiveness of combined ATFL and CFL repair versus ATFL-only repair for severe chronic lateral ankle instability
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Updated: Apr 13, 2026
Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus
Published on: January 23, 2018
Kensei Yoshimoto1,2, Masahiko Noguchi2, Ayako Tominaga1,2
1Department of Orthopedic Surgery Tokyo Women's Medical University Shinjuku-ku Tokyo Japan.
Purpose:
Repairing only the anterior talofibular ligament (ATFL) remnant in severe chronic lateral ankle instability (CLAI) with a concurrent calcaneofibular ligament (CFL) injury can result in persistent instability, highlighting the need to include CFL repair. Thus, this study aimed to examine the effectiveness of combined CFL and ATFL repair in severe CLAI with a concurrent CFL injury.
Methods:
Eighty ankles from 77 patients with severe CLAI with a concurrent CFL injury who underwent lateral ankle ligament repair were retrospectively examined. Severe CLAI with a concurrent CFL injury was defined as an ATFL that exhibited no mechanical resistance to hook palpation during arthroscopy. Among them, 39 ankles from 38 patients underwent arthroscopic ATFL repair between 2018 and 2021 (ATFL-only group), whereas 41 ankles from 39 patients underwent open ATFL and CFL repair between 2021 and 2024 (CFL-repair group). Outcomes included recurrent ankle instability (respraining of the operated ankle following surgery) and Self-Administered Foot Evaluation Questionnaire (SAFE-Q) scores.
Results:
No significant differences were observed between patient demographics in the two groups. Overall, 16 (41.0%) cases of recurrent ankle instability were observed in the ATFL-only group compared with 7 (17.1%) in the CFL-repair group, showing a significant difference (p = 0.026). No significant differences were found in the postoperative SAFE-Q scores between the two groups. Multivariate analysis adjusted for age, sex, body mass index, follow-up periods and sports participation revealed that ATFL-only repair was associated with a significantly higher risk of recurrent ankle instability compared with combined ATFL and CFL repair.
Conclusion:
Although no significant difference was observed in postoperative SAFE-Q scores between the two groups, repairing ATFL along with CFL could be more effective in achieving stable ankle than ATFL-only repair for severe CLAI with a concurrent CFL injury.
Level Of Evidence:
Level Ⅳ.
