Negative impact of increasing age on clinical outcomes of arthroscopic lateral ankle ligament repair for chronic lateral ankle instability

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Abstract
Purpose: Arthroscopic lateral ankle ligament repair is gaining popularity for chronic lateral ankle instability (CLAI). Several studies have reported excellent outcomes with this procedure. However, the effect of age on clinical outcomes remains unclear, particularly factors that may lead to poor postoperative outcomes. This study aimed to analyze the effect of age on the clinical outcomes of arthroscopic repair for CLAI. Methods: Seventy‐five ankles of 69 patients (35.6 ± 15.8 years) that underwent arthroscopic anterior talofibular ligament (ATFL) repair with calcaneofibular ligament (CFL) repair for CLAI between February 2019 and December 2023 were retrospectively reviewed. In these patients, arthroscopic ATFL repair was performed with additional CFL repair if the varus instability remained. The clinical outcomes, including the Japanese Society for Surgery of the Foot (JSSF) hindfoot‐ankle scale, Karlsson‐Peterson (K‐P) score and Self‐Administered Foot Evaluation Questionnaire (SAFE‐Q) score, were evaluated preoperatively and at the final follow‐up. The patients were classified into younger (<40 years) and older (≥40 years) groups, and the outcomes were compared. Results: The mean follow‐up period was 15.3 ± 7.2 months. The JSSF scale, K‐P and all SAFE‐Q subscale scores significantly improved postoperatively. Nineteen ankles exhibited recurrent instability (25.3%); however, no ankles required revision surgery. Age was negatively correlated with postoperative clinical scores. K‐P score was significantly lower in the older group than in the younger group preoperatively. Postoperatively, the JSSF scale, K‐P score, pain and pain‐related, and general health and well‐being on the SAFE‐Q subscale were significantly lower in the older group than in the younger group. Multiple regression analysis revealed a significant association of age, preoperative JSSF scale, and SAFE‐Q preoperative social functioning and general health and well‐being subscales with postoperative JSSF scale. Conclusions: Increasing age negatively affects the clinical outcomes of arthroscopic repair for CLAI due to residual pain and poor mental health. Level of Evidence: Level IV, retrospective case series.

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