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.