SLR - January 2022 - Elliott N. Wityk

Clinical Outcomes of Anterior Tibiofibular Ligament’s Distal Fascicle Transfer Versus Ligament Reconstruction with Internalbrace™ For Chronic Ankle Instability Patients

Reference: Tian J, Mok TN, Sin TH, Zha Z, Zheng X, Teng Q, Hou H. Clinical outcomes of anterior tibiofibular ligament's distal fascicle transfer versus ligament reconstruction with InternalBrace™ for chronic ankle instability patients. Arch Orthop Trauma Surg. 2021 Nov 30. doi: 10.1007/s00402-021-04214-2. Epub ahead of print. PMID: 34846587.

Level of Evidence: Level 3-Retrospective Study

Scientific Literature Review

Reviewed By: Elliott N. Wityk, DPM
Residency Program: John Peter Smith Hospital – Fort Worth TX

Podiatric Relevance: Surgical treatment for chronic ankle instability is a contested topic. The authors of this article sought to compare clinical outcomes of transferring the AITFL distal fascicle (Bassett’s ligament) vs ligament reconstruction with the InternalBrace (Arthrex), both via arthroscopic technique.

Methods: The authors enrolled 29 patients (13 underwent distal fascicle transfer, 16 underwent ligament reconstruction with the InternalBrace). There was no randomization for this study. One senior orthopedic surgeon determined which patient received which procedure at their sole discretion. Both procedures were performed under arthroscopic examination. Patients were immobilized for two months post operatively in a short leg cast, followed by physical therapy and eventual return to activity at three months. Postoperative evaluation was performed by one additional separate orthopedic surgeon who did not perform/partake in the procedure or have knowledge of any participant. Patients returned at 1, 2, 6, 12, and 16 months postoperatively. The AOFAS score was used for outcome measurement of functional status. Patient satisfaction was also recorded via questionnaire (scale 0 to 10 with 10 being most satisfied).

Results: T
he two groups had no significant difference in preoperative baseline characteristics. There was also no significant difference in outcome for two of the subjective measurements (VAS, patient satisfaction) or objective measurements (anterior drawer). However, there was a statistically significant difference in AOFAS score with a score of 86.45 (good) in the internal brace group compared to 89.85 (excellent)  in the AITFL distal fascicle transfer.

Conclusions: Distal fascicle (Bassett’s ligament) transfer provides similar results, complications rates and patient satisfaction compared to ligament reconstruction with the InternalBrace. This research serves as a baseline indicating distal fascicle transfer may be a viable option considering its economic superiority over the InternalBrace system. The distal fascicle transfer is also demonstrated to be a practical consideration for chronic lateral ankle instability for surgeons with experience in arthroscopic technique. 

Educational Opportunities