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04/05/2021

UCA Clinical Case: Arthroscopic repair of the anterior talofibular ligament

We go through the clinical case of a 22-year-old patient and professional football player who presents a 5-month-evolution sprain of the right ankle. During this time two injections have been performed, but he has reached a point where he cannot train without pain, so we are looking for a solution to put an end to this injury.

Physical examination

During the examination we found a swollen ankle, varus laxity and anterior drawer. Hypermobility of the subtalar joint and pain when palpating the anterior aspect of the external lateral ligament were both detected.

Forced X-rays

Forced radiographs were performed showing a varus laxity of less than 10º and anterior drawer +. Slight laxity in varus without drawer.

MRI

An oedema is found in the supero-external angle of the talus bone. Anterior talofibular ligament injury. Posterior subtalar oedema, tibialis talus stroke. Thickened deltoid ligament.

CT scan

The CT scan shows a minimal osteochondral injury in the external aspect of the talar dome with a small non-displaced bone fragment.

Treatment

A conservative treatment is carried out with an intra-articularly performed intraosseous PRGF infiltration in the talus and the anterior talofibular ligament. It is related to physiotherapeutic treatment and improves the examination of the anterior drawer and laxity.

Arthroscopic debridement is performed due to a selective pain located in the anterior talofibular ligament. Moreover, the anterior talofibular ligament is repaired as we can see below.