Is it necessary to remove small fibular ossicles during an arthroscopic modified Broström operation for chronic lateral ankle instability?

BACKGROUND

Ankle sprains are the most frequent musculoskeletal injury in sports. Patients reporting pain at the lateral malleolus tip following ankle sprains or sports activities frequently have separated ossicles, referred to as an os subfibulare (OSF). Commonly, small ossicles accompanied by chronic lateral ankle instability (CLAI) are treated with ossicle resection combined with the modified Broström operation (MBO). We compared the clinical and radiological results between groups in which a small OSF was or was not removed.

METHODS

We retrospectively enrolled all patients with a small OSF who underwent arthroscopic MBO by one surgeon in one institution between 2015 and 2022. The study included skeletally mature patients who had an OSF among those who had MBO surgery and follow-up for at least 1 year. An ossicle was defined as small if the longitudinal diameter was < 5 mm on an anteroposterior plain radiograph.

RESULTS

There were no significant differences between the groups preoperatively or 6 or 12 months postoperatively. The radiographic findings did not differ significantly between groups.

CONCLUSIONS

When performing arthroscopic MBO on patients with CLAI, OSF ≤ 5 mm removal did not alter clinical or radiological outcomes, suggesting that excision may not be needed in asymptomatic patients. Considering the risks of the removal process, leaving it alone may be a treatment option.

CLINICAL TRIAL NUMBER: Not applicable.