Excellent functional outcomes without physeal violation after arthroscopic all‐inside ligament repair for ankle instability in skeletally immature patients

Purpose Arthroscopic all-inside ligament repair is a widely used technique for treating chronic lateral ankle instability. This study aimed to evaluate the clinical outcomes of skeletally immature patients who underwent all-inside ligament repair. Methods Skeletally immature patients who underwent surgery for ankle instability between 2018 and 2022 were retrospectively evaluated. All patients were treated arthroscopically using an all-inside ligament repair technique, allowing an all-epiphyseal anatomical repair of the ligament remnant. Clinical outcomes were assessed pre- and postoperatively using Visual Analogue Scale (VAS), Foot Functional Index (FFI) score and Foot and Ankle Ability Measure–Sports subscale (FAAM-SS). Postoperative magnetic resonance imaging (MRI) was routinely performed at 3 months to evaluate ligament repair and detect any physeal violation. At final follow-up, patient satisfaction, complications, lower-limb axial deviations or clinical signs of physeal violation were recorded. Results Forty patients aged 8–15 years (21 females; mean age 13.8 ± 2.3 years) were included. Mean follow-up was 44.8 months ± 16.5 (range, 24–78). An anterior talofibular ligament (ATFL) tear was identified in all cases, with concomitant calcaneofibular ligament detachment observed in four patients. All clinical scores improved significantly (p < 0.001). Mean FFI and FAAM-SS scores improved from 35.6 ± 14.0 (range, 11–69) and 50.3 ± 14.0 (range, 15–78) preoperatively to 3.9 ± 6.4 (range, 0–26) and 95.4 ± 8.3 (range, 68–100) postoperatively. Mean VAS improved from 5.4 ± 2.5 (range, 1–8) to 0.4 ± 0.8 (range, 0–3). No cases of physeal violation were detected on postoperative MRI. No major complications, axial deviation or clinical signs of growth plate injury were observed. Conclusions Ankle instability in skeletally immature patients can be successfully treated with arthroscopic all-inside ligament repair. This technique provides an all-epiphyseal anatomical repair of the ligament remnant with a low risk of physeal violation and results in excellent clinical outcomes.