Simultaneous ossicle resection and lateral ligament repair give excellent clinical results with an early return to physical activity in pediatric and adolescent patients with chronic lateral ankle instability and os subfibulare

  • Maya Kubo
  • Youichi YasuiEmail author
  • Jun Sasahara
  • Shinya Miki
  • Hirotaka Kawano
  • Wataru Miyamoto



To elucidate surgical outcomes in pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare.


A retrospective chart review was conducted of pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare following simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active range of motion exercises for the ankle in our department between 2013 and 2017. Clinical outcomes were evaluated by comparing preoperative and final follow-up American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and Karlsson-Peterson ankle function scores. Intervals between surgery and return to physical education in school were determined.


31 feet of 15 male and 16 female patients were examined. Mean postoperative follow-up duration was 40.7 ± 12.7 (range 24–66) months. Mean AOFAS score increased significantly from 66.3 ± 2.5 (range 62–77) preoperatively to 96.5 ± 4.9 (range 87–100) at final follow-up (p < 0.001). Mean Karlsson-Peterson score increased significantly from 51.7 ± 4.0 (range 47–70) preoperatively to 95.3 ± 6.7 (range 80–100) at final follow-up (p < 0.001). Mean interval between surgery and return to physical education in school was 11.4 ± 1.6 (range 10–18) weeks.


Simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active ankle range of motion exercises may give excellent clinical outcomes with early return to physical activity for chronic lateral ankle instability with os subfibulare in pediatric/adolescent patients desiring an early return to physical activity.

Level of evidence



Ossicle resection Lateral ligament repair Early return to physical activity Chronic lateral ankle instability Os subfibulare 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


No funding has been provided for this research.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of Teikyo University (No: 16-063) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryTeikyo University School of MedicineTokyoJapan

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