scholarly journals Early Versus Delayed Mobilization Postoperative Protocols for Lateral Ankle Ligament Repair: A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092525 ◽  
Author(s):  
Matthew L. Vopat ◽  
Armin Tarakemeh ◽  
Brandon Morris ◽  
Maaz Hassan ◽  
Pat Garvin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Anterior Drawer ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Talar Tilt ◽  
Primary Lateral

Background: The majority of patients with an acute lateral ankle ligamentous injury are successfully treated nonoperatively with functional rehabilitation; however, a small proportion of these patients experience persistent chronic instability and may require surgical intervention. Delayed primary repair of the ruptured ligaments is most commonly indicated for these patients. Optimal rehabilitation after lateral ankle ligament repair remains unknown, as surgeons vary in how they balance protection of the surgical repair site with immobilization against the need for ankle joint mobilization to restore optimal postoperative ankle range of motion. Purpose: To compare early and delayed mobilization (EM and DM, respectively) postoperative protocols in patients undergoing primary lateral ankle ligament repair to determine optimal evidence-based rehabilitation recommendations. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a meta-analysis using the PubMed/Ovid MEDLINE database was performed (October 11, 1947 to October 16, 2017), searching for articles involving lateral ankle ligament repair. Postoperative protocols were reviewed and divided into 2 categories: EM (within 3 weeks of surgery) and DM (more than 3 weeks post surgery). Return to sport (RTS), outcome scores (American Orthopaedic Foot and Ankle Society [AOFAS] ankle-hindfoot scale and Karlsson score), radiographic outcomes (talar tilt and anterior drawer), and complications of both populations were recorded and statistically analyzed. Results: A total of 28 of 1574 studies met the criteria for the final analysis, comprising 1457 patients undergoing primary lateral ankle ligament repair. The postoperative AOFAS score was significantly greater in the EM versus DM group (98.8 vs 91.9, respectively; P < .001), as was the postoperative Karlsson score (92.2 vs 90.0, respectively; P < .001). However, the EM group had significantly greater postoperative laxity on both the anterior drawer test (6.3 vs 3.9 mm, respectively; P < .001) and talar tilt test (5.1° vs 4.5°, respectively; P < .001). Also, the DM group had significantly lower rates of overall complications (3.1% vs 11.4%, respectively; P < .001) and skin wound complications (1.3% vs 3.8%, respectively; P = .005). RTS was not significantly different between groups ( P = .100). Conclusion: Patients with EM postoperative protocols demonstrated improved functional outcomes; however, the EM group had increased objective laxity and a higher complication rate. Additional randomized studies are needed to definitively evaluate early versus delayed rehabilitation protocol timetables to optimize functional outcomes without compromising long-term stability.

scholarly journals Early versus Delayed Mobilization Post-Operative Protocols for Primary Lateral Ankle Ligament Repair: A Systematic Review and Meta-analysis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0007
Author(s):  
Matthew L. Vopat ◽  
Armin Tarakemeh ◽  
Brandon Morris ◽  
Maaz Hassan ◽  
Pat Garvin ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Meta Analysis ◽  
Return To Sport ◽  
Early Mobilization ◽  
Lateral Ligament ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Primary Lateral

Category: Ankle, Sports, Post-op protocol Introduction/Purpose: Lateral ankle instability represents a common orthopaedic diagnosis. Nonoperative treatment through focused physical therapy provides satisfactory results in most patients. Some patients, however, experience persistent chronic lateral ankle instability despite appropriate nonoperative treatment. These patients may require stabilization which can include primary lateral ligament repair to restore ankle stability. Optimal post-operative rehabilitation of lateral ankle ligament repairs remains unknown, as surgeon vary in how they balance protection of surgical repair with immobilization with the need for ankle joint mobilization to restore range of motion. The aim of this review is to provide insight into early and delayed mobilization post- operative protocols in patients undergoing primary lateral ankle ligament repairs to determine if an optimal evidence-based post- operative rehabilitation protocol exists in the literature. Methods: Following PRIMSA criteria, a meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947- 10/16/2017). Manuscripts that were duplicates, non-lateral ligament repair, biomechanical and non-English language were excluded. Protocols were reviewed and divided into two categories; early mobilization (within 3 weeks of surgery) and delayed mobilization (after 4 weeks of surgery). Return to sport, outcome scores (AOFAS, Karlsson scores) and complications of both populations were recorded and statistically analyzed. Results: 31 out of 1,844 studies met the criteria for the final analysis, representing 1,608 patients undergoing primary lateral ligament repair. There was no statistical difference in pre-operative AOFAS scores with delayed mobilization having a score of 67.3 and early mobilization having a score of 67.6 (p<0.639). There was statistical significance in the post-operative AOFAS score comparing delayed mobilization group versus early mobilization group with 91.8 versus 98.8, respectively (p<0.001) and post- operative Karlsson scores with values of 90.0 vs. 92.2 in delayed versus early respectively (p<0.001). Return to sport in the delayed group was 11.8 weeks versus 10.9 in early (p<0.044). No significant difference was found in complication rates between groups with delayed having a rate of 3.7% and early 4.8% (p<0.389). Conclusion: Patients may benefit from early mobilization protocols after lateral ankle ligament repair. The early mobilization protocols group had improved functional outcomes and decreased time until return to sport without a difference in complications. More studies are needed to definitively evaluate early versus delayed rehabilitation protocols due to heterogeneity of the studies.

scholarly journals Early Versus Delayed Mobilization Post-Operative Protocols for Primary Lateral Ankle Ligament Reconstruction: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 14 ◽  
pp. 141-148
Author(s):  
Matthew Vopat ◽  
Alexander Wendling ◽  
Brennan Lee ◽  
Maaz Hassan ◽  
Brandon Morris ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Meta Analysis ◽  
Early Mobilization ◽  
Lateral Ligament ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Lateral Ankle Ligament Reconstruction ◽  
Primary Lateral

Introduction. Lateral ankle instability represents a common orthopaedic diagnosis. Nonoperative treatment through focused physical therapy provides satisfactory results in most patients. However, some patients experience persistent chronic lateral ankle instability despite appropriate nonoperative treatment. These patients may require stabilization which can include primary lateral ligament reconstruction with a graft to restore ankle stability. Optimal post-operative rehabilitation of lateral ankle ligament reconstruction remains unknown, as surgeons vary in how long they immobilize their patients post-operatively. The aim of this review is to provide insight into early mobilization (EM) versus delayed mobilization (DM) post-operative protocols in patients undergoing primary lateral ankle ligament reconstructions to determine if an optimal evidence-based post-operative rehabilitation protocol exists in the literature. Methods. Following PRIMSA criteria, a systematic review/meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947-1/28/2020). Manuscripts that were duplicates, non-lateral ligament repair, biomechanical and non-English language were excluded. Protocols were reviewed and divided into two categories; early mobilization (within 3 weeks of surgery) and delayed mobilization (after 3 weeks of surgery). Functional outcome scores (AOFAS, Karlsson scores), radiographic measurements (anterior drawer, talar tilt) and complications evaluated using weighted mean differences (pre- and post-operative scores) and mixed-effect models. Results. After our search, we found 12 out of 1,574 studies that met the criteria for the final analysis, representing 399 patients undergoing lateral ankle reconstruction. Using weighted mean differences the DM group showed superior AOFAS functional scores compared to the EM group; 28.0 (5.5) vs. 26.3 (0.0) respectively, p < 0.001; although sample size was small. Conversely, no significant differences were found for Karlsson functional score (p = 0.246). With regards to radiographic outcome, no significant differences were observed; anterior drawer was p = 0.244 and talar tilt was p = 0.937. A meta-analysis using mixed-effects models confirmed these results, although heterogeneity was high. Conclusions. While there were some conflicting results, findings suggest that EM post-operative protocols for patients undergoing lateral ankle ligament reconstruction may not compromise functional outcomes or post-operative stability. Because heterogeneity was high, future studies are still needed to evaluate these protocols in less diverse patient groups and/or more consistent techniques for lateral ankle ligament reconstruction.

scholarly journals Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0038
Author(s):  
Yoshiharu Shimozono ◽  
Alexandra J Brown ◽  
Eoghan T Hurley ◽  
John G Kennedy
Keyword(s):  
Systematic Review ◽  
Comparative Studies ◽  
Ankle Instability ◽  
Arthroscopic Repair ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Lateral Ankle Ligament

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Open modified Broström-Gould procedure is generally accepted as the gold-standard treatment for chronic lateral ankle instability. Recently an arthroscopic lateral ankle ligament repair technique has become increasingly popular in an effort to reduce post-operative pain and facilitate early recovery. The purpose of the current systematic review was to evaluate the current evidence on arthroscopic lateral ankle ligament repair techniques and to compare the clinical outcomes of arthroscopic and open techniques for chronic lateral ankle instability with meta-analysis. Methods: A systematic search of MEDLINE and EMBASE databases was performed during August 2017. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Comparative studies were compared using RevMan version 5.3, and a p-value of < 0.05 was considered statistically significant. Results: Twelve studies for a total of 421 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. There were three comparative studies of open and arthroscopic repair procedures, with two Level III studies and one Level I study. There was a significant difference in favor of arthroscopic repair at final follow-up for the Karlsson- Peterson score (MD; 2.59, 95%CI, -0.19 to 2.36, I2=0%, p=0.10) and the AOFAS score (MD; 1.50, 95%CI, 0.41 to 2.59, I2=0%, p=0.007) in the comparative studies. The overall complication rate was 13.4% in the included studies but in the comparative studies there was no statistically significant difference between open and arthroscopic repair (12.1% vs 11.4%, p=0.90). Conclusion: The current systematic review demonstrated that arthroscopic lateral ankle ligament repair may yield favorable clinical outcomes and may be superior to open procedure in the short-term, but there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure in the mid- long-term follow-up. There was a relatively high complication rate associated with the arthroscopic procedures, with a 13.4% complication rate, although recent comparative studies demonstrated similar complication rates.

Sex-Specific Differences Following Lateral Ankle Ligament Repair

2021 ◽  
pp. 107110072110041
Author(s):  
Ezra Goodrich ◽  
Matthew L. Vopat ◽  
Jordan Baker ◽  
Armin Tarakemeh ◽  
Kimberly Templeton ◽  
...  
Keyword(s):  
Success Rate ◽  
Ankle Instability ◽  
Postoperative Outcomes ◽  
Lateral Ligament ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Males And Females ◽  
Primary Lateral

Background: Chronic ankle instability is a common condition that can be treated with lateral ankle ligament repair. These procedures have a reported success rate greater than 85% in the literature, but little has been reported about the differences in postoperative outcomes between males and females. The purpose of this study was to evaluate sex-specific outcomes following lateral ankle ligament repair. Methods: In this systematic review and meta-analysis, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to search for articles on electronic databases and included studies in which study participants underwent primary lateral ligament repair and sex-specific outcomes were evaluated. Functional postoperative outcomes for males and females were recorded and statistically analyzed. Results: Out of 2768 studies, 7 (0.25%) met inclusion criteria and were analyzed in this review. These studies included 618 patients (402 males [65%] and 216 females [35%]) who underwent primary lateral ligament repair for ankle instability. Karlsson score ( P = .1582) and American Orthopaedic Foot & Ankle Society (AOFAS) score ( P = .1586) analyses found no statistically significant difference between males and females. Postoperative success rate—defined as a “good” or “excellent” Karlsson score (>81)—was not found to be significantly different between males and females ( P = .9374). Conclusion: There was no difference in postoperative mean Karlsson scores, AOFAS scores, or success rates between males and females who underwent primary lateral ankle ligament repair. Level of Evidence: Level IV, therapeutic.

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