Arthroscopic management of ankle ligament injuries: a new gold standard?

Ankle ligament injuries are among the most common lesions encountered in emergency medicine and in chronic contexts. The present study aimed to assess the role of arthroscopy, addressing 5 questions. (1) What are the indications for surgery in ankle ligament injury? - In the acute phase, conservative treatment is the rule, but surgery may be considered for lateral lesions, in first injury in athletes with high functional demand, and in case of associated proximal lesions in the anterior talofibular ligament and calcaneofibular ligament. Surgery is also indicated for unstable lesions in the distal tibiofibular syndesmosis or medial collateral ligament. In chronic contexts, surgery is indicated for persistent instability despite rehabilitation. (2) What is the contribution of arthroscopy? - It enables precise diagnosis of ligament status and associated lesions, and anatomic repair of all lesions. It is now the gold-standard for syndesmosis assessment. (3) How to perform surgery? - In the acute phase, arthroscopic techniques consist in repair by ligament suture. In chronic contexts, they consist in repair or reconstruction by autograft or allograft. The techniques are well codified. 4) What are the expected results? - The literature reports functional results equivalent to or better than for open surgery, with fewer complications, quicker return to sport and better patient satisfaction. 5) Can this be considered a new gold-standard? - Reports of clinical series indicate that arthroscopic stabilization is becoming the new gold-standard for chronic ankle ligament instability. This needs to be confirmed in larger-scale studies with longer follow-up. LEVEL OF EVIDENCE: 5, expert opinion.