Evolution in Surgical Management of Ankle Instability in Athletes

Brian C. Lau, MD; Alexej Barg, MD; C. Thomas Haytmanek, MD; Kirk McCullough, MD; Annunziato Amendola, MD


J Am Acad Orthop Surg. 2021;29(1):e5-e13. 

In This Article

Use of Suture Anchors

Traditional lateral ligament repair involved suture repair through bone tunnels, but the use of suture anchors has dramatically increased in recent years.[14] Biomechanical studies showed no significant difference in load to failure between the two constructs.[15] Clinical studies also demonstrated no significant difference in outcomes, as measured by Karlsson and Sefton scales.[15] A recent report demonstrated, however, that the suture anchor construct had significantly lower complication rates (9%) compared with direct suture reattachment (28.8%).[12] The difference may be related to the degree of surgical dissection required for each approach. Direct suture repair with transosseous tunnels require greater periosteal stripping and bicortical drilling to create the tunnel. The use of suture anchors decreases surgical time and, for surgeons who do not do many ankle stabilizations, may also be more reproducible and easier to do. The expense of suture anchors does significantly increase costs compared with traditional bone tunnels. The use of two or three suture anchors has not been shown to provide an appreciable clinical difference in outcomes.[12,15,16]

Suture anchors are an efficient way to achieve fixation. The process is simple, reproducible, and decreases surgical dissection while decreasing complications. However, an increase in cost is noted with the use of suture anchors compared with suture alone through bone tunnels.