Journal of Foot and Ankle Surgery - 2026-08-05 - Journal Article
Clinical Application of 3D Printing in Non-Arthroscopic Ankle Ligament Reconstruction: A Single-Center Retrospective Study.
Luo K, Sun L, Lu K, Du Z, Ren Y, Suo Y, Xiang Y
Topics
Key Takeaway
3D-printed personalized guide plates reduced operation time by ~9 minutes (35.4 vs 44.8 min) and cut intraoperative fluoroscopic exposures by more than half (1.58 vs 3.33) compared to conventional non-arthroscopic lateral ankle ligament reconstruction.
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Summary
This single-center retrospective study compared 3D-printed personalized guide plates versus conventional technique for non-arthroscopic CLAI reconstruction in 48 consecutively enrolled patients allocated by surgery date. The template group achieved significantly shorter operative time (35.4 vs 44.8 min, p<0.001) and fewer fluoroscopic exposures (1.58 vs 3.33, p<0.001). AOFAS, VAS, and Karlsson scores improved in both groups with no significant between-group difference at final follow-up, and all patients had negative anterior drawer and talar tilt tests postoperatively.
Key Limitation
The non-randomized, chronological allocation means the conventional group was operated on earlier, conflating learning curve effects and potential temporal changes in perioperative care with the guide plate intervention itself.
Original Abstract
BACKGROUND
Chronic lateral ankle instability (CLAI) often requires anatomic ligament reconstruction after failed conservative treatment. Precise bone tunnel placement remains challenging during traditional open surgery.
PURPOSE
To evaluate the clinical value of three-dimensional (3D) printed personalized guide plates for improving surgical precision and reducing intraoperative radiation exposure during lateral ankle ligament reconstruction.
STUDY DESIGN
Retrospective comparative cohort study.
METHODS
Forty-eight patients with CLAI were consecutively enrolled and allocated by surgery date to a template group (n = 24) or a conventional group (n = 24). Primary outcomes included operation time, intraoperative fluoroscopy frequency, and radiation exposure time. Secondary outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) score, Visual Analog Scale (VAS), and Karlsson score. The VAS, which measures patient-reported pain intensity on a 10-cm line, was completed independently without surgeon interference. Clinical stability was assessed using the Anterior Drawer and Talar Tilt tests.
RESULTS
All patients completed 12-20 months of follow-up (mean, 14.5 ± 5.5 months). Compared with the conventional group, the template group had a shorter operation time (35.42 ± 5.23 vs. 44.79 ± 6.85 min, p < 0.001) and fewer fluoroscopic exposures (1.58 ± 0.65 vs. 3.33 ± 0.48, p < 0.001). No significant between-group differences were observed in AOFAS, VAS, or Karlsson scores at the final follow-up (all p > 0.05). Both groups had negative Anterior Drawer and Talar Tilt tests postoperatively, indicating successful stabilization.
CONCLUSIONS
Compared with conventional surgery, 3D-printed guide-assisted surgery significantly reduced operation time, intraoperative positioning time, and radiation exposure. It is a promising and efficient approach for non-arthroscopic ankle ligament reconstruction.
LEVEL OF CLINICAL EVIDENCE
3.