Outcomes of arthroscopic-assisted mini-open anatomic reconstruction using autologous tendon for ankle ligament injuries and its effect on functional recovery.

OBJECTIVE

To compare the efficacy of arthroscopic anatomic reconstruction using autologous versus allogeneic tendons in restoration of ankle function following ligament injuries.

METHODS

We conducted a retrospective cohort study and enrolled 210 consecutive patients with ankle ligament injuries treated between June 2021 and June 2024. Participants were allocated to autograft (n = 106) or allograft (n = 104) groups based on surgical selection. Propensity score matching (1:1) yielded 55 patients per group. We analyzed clinical data, six imaging parameters (Grades 0-III), and functional scores (AOFAS, Tegner, VAS, medial compartment displacement [Mcd], medial space difference [Msd]), examining their interrelationships. Generalized estimating equations (GEE) modeled functional score changes pre-/post-operatively.

RESULTS

Both groups showed improved imaging grades and functional scores postoperatively. The autograft group achieved superior outcomes: medial/lateral collateral ligament grades recovered from mean grade III to 0 (P < 0.05 vs. allograft); AOFAS increased from 58.96 ± 7.34 to 90.71 ± 14.78(P < 0.05). Significant intergroup differences persisted in collateral ligament grades and functional scores (all P < 0.05).Pre- to postoperative changes in ligament grades significantly correlated with functional score improvements (P < 0.05). Improvements in imaging parameters strongly correlated with functional score enhancement rates (P < 0.05), particularly for anterior/posterior tibiotalar ligaments. GEE modeling demonstrated significantly greater functional gains in the autograft group: AOFAS (β = 1.656, P < 0.001), Tegner (β = 1.172, P = 0.005), and greater reductions in VAS (β = -2.532, P < 0.001), Mcd (β = -2.288, P < 0.001), and Msd (β = -1.957, P < 0.001).

CONCLUSION

Arthroscopic autologous tendon reconstruction yields superior ligament integrity and functional recovery compared with allograft reconstruction.