Arthroscopic Anatomic Reconstruction of the Interosseous Talocalcaneal Ligament Using a Gracilis Autograft for Subtalar Instability: 6- to 12-Year Retrospective Follow-up

Abstract

Background: Several surgical techniques have been reported of subtalar instability (STI), but it remains a controversial topic without long-term clinical evidence. This study aimed to report the all-inside arthroscopic anatomic interosseous talocalcaneal ligament (ITCL) reconstruction technique and its long-term outcomes in STI patients with confirmed ITCL rupture. Methods: A retrospective study was conducted on consecutive series of STI patients who underwent all-inside arthroscopic anatomic reconstruction of the ITCL using a gracilis autograft between January 2010 and December 2016. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, Karlsson-Peterson score, visual analog scale (VAS) pain score, and Tegner activity scale were assessed preoperatively and postoperatively. Furthermore, Foot and Ankle Ability Measure activities of daily living (FAAM-ADL) and sports (FAAM-Sports) scores, and whether patients returned to daily work, recreational activities, and preinjury sports were recorded at follow-up. Complications including postoperative sprain recurrence, range of motion (ROM) restriction, and incision numbness were evaluated at the final follow-up. Results: A total of 25 patients, with a mean age of 33.3 ± 8.8 years, were included in the follow-up analysis at a mean duration of 110.7 ± 20.4 months. The mean Karlsson-Peterson and AOFAS scores significantly increased from 61.8 ± 9.9 preoperatively to 93.8 ± 7.2 ( P < .001) at the final follow-up and from 68.8 ± 7.4 to 95.1 ± 6.7 ( P < .001), respectively. Additionally, the mean VAS pain score significantly decreased from 4.5 ± 1.1 to 0.6 ± 1.0 ( P < .001). Regarding normal daily activities (FAAM-ADL), 22 patients (88%) obtained good to excellent (≥80) results; for sports-related activities, 18 patients (72%) had good to excellent FAAM-Sports scores and 19 patients (76%) returned to preinjury sports activities. Four patients (16%) reported mild to moderate ROM restrictions. Conclusion: All-inside arthroscopic anatomic reconstruction of the ITCL demonstrated with gracilis autograft was associated with satisfactory long-term outcomes in restoring function and facilitating a return to sports for STI patients with ITCL injury.