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.

scholarly journals Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0044
Author(s):  
Yoshiharu Shimozono ◽  
Eoghan Hurley ◽  
John Kennedy
Keyword(s):  
Clinical Outcomes ◽  
Complication Rate ◽  
Comparative Studies ◽  
Ankle Instability ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Lateral Ankle Ligament

Category: Ankle Introduction/Purpose: There has a been recent increase in the use of the arthroscopic approach to lateral ankle ligament repair for chronic lateral ankle instability. However, the clinical outcomes of this technique are still unclear. The purpose of this systematic review was to evaluate the current studies on arthroscopic lateral ankle ligament repair for chronic lateral ankle instability. Our hypothesis was that arthroscopic lateral ligament repair would result in excellent outcomes with a low complication rate. Methods: A systematic search of MEDLINE, EMBASE and Cochrane Library databases, based on the PRISMA guidelines, was performed during August 2017 by 2 independent reviewers. 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. 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. The weighted mean preoperative AOFAS score improved from 59.6 to 95.0 at a mean follow-up of 14.8 months in 8 studies. Five studies utilized Karlsson-Peterson scores with mean postoperative score of 88.5 at a mean follow-up of 21.2 months. Three comparative studies were reported. The comparative studies showed similar clinical outcomes between arthroscopic and open procedures. The overall complication rate was 13.4% in the included studies. . Only 2 studies reported patients returning to sport and demonstrated that 100% of patients returned to sport at pre-injury level. Conclusion: The current systematic review demonstrated that arthroscopic lateral ankle ligament repair yields favorable clinical outcomes in the short-term. However, there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure, and there is no long-term data currently available for the arthroscopic procedure. 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 for both open and arthroscopic techniques.

scholarly journals Outcomes of Open Versus Arthroscopic Broström Surgery for Chronic Lateral Ankle Instability: A Systematic Review and Meta-analysis of Comparative Studies

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110152
Author(s):  
Ahmed Khalil Attia ◽  
Tarek Taha ◽  
Karim Mahmoud ◽  
Kenneth J. Hunt ◽  
Sameh A. Labib ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Comparative Studies ◽  
Open Surgery ◽  
Ankle Instability ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Vas Scores ◽  
Talar Tilt

Background: Nearly 20% of acute ankle sprains progress to chronic lateral ankle instability that requires surgical intervention. In recent years, there has been a growing interest in arthroscopic Broström techniques as an alternative to open surgery. Purpose: To review the most up-to-date evidence comparing the outcomes of open and arthroscopic Broström procedures for chronic lateral ankle instability. Study Design: Systematic review; Level of evidence, 3. Methods: This review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant comparative studies in English up to May 2020 were identified. The primary outcomes were (1) functional scores (Karlsson Ankle Function Score and American Orthopaedic Foot & Ankle Society [AOFAS] score) and (2) the 10-point visual analog scale (VAS) score for pain. The secondary outcomes were differences in (1) postoperative anterior drawer and talar tilt, (2) surgical time and complication rate, and (3) time to return to sports and weightbearing. Results: A total of 408 patients in 8 studies met the inclusion criteria. Of these, 193 (47.3%) patients underwent open surgery, while 215 (52.7%) patients underwent arthroscopic surgery. There were significant differences between the open and arthroscopic repair groups in mean 6-month AOFAS scores (82.4 vs 92.25, respectively; mean difference [MD], 11.36; 95% CI, 0.14-2.56; I 2 = 90%; P = .03), 1-year AOFAS scores (80.05 vs 88.6; MD, –11.96; 95% CI, –21.26 to –2.76; I 2 = 82%; P = .01), 6-month VAS scores (1.7 vs 1.4; MD, –0.38; 95% CI, –0.54 to –0.21; I 2 = 78%; P < .001), and 1-year VAS scores (2.05 vs 1.45; MD, 0.31; 95% CI, 0.09-0.54; I 2 = 0%; P < .001). The mean time to weightbearing was 14.25 and 9.0 weeks in the open and arthroscopic repair groups, respectively (MD, 1.89; 95% CI, 1.24-2.54; I 2 = 99%; P < .001). There were no statistically significant differences in the remaining outcomes evaluated. Conclusion: While technically more demanding, arthroscopic Broström was superior to open Broström-Gould surgery in postoperative AOFAS scores, VAS pain scores, and time to return to weightbearing. The operative time, complication rate, talar tilt, and anterior drawer tests were excellent and statistically comparable. Long-term clinical trials are required before recommending arthroscopic Broström as the new gold standard.

Chronic Lateral Ankle Instability

Foot & Ankle ◽  
1991 ◽  
Vol 12 (3) ◽  
pp. 182-191 ◽  
Author(s):  
J. Wesley Peters ◽  
Saul G. Trevino ◽  
Per A. Renstrom
Keyword(s):  
Operative Treatment ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Management Options ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Anatomical Point ◽  
Lateral Ankle Ligament

Chronic lateral ankle instability may be present in as many as 10% to 30% of people suffering from acute lateral ankle ligament injuries. Ankle instability has been referred to as either functional instability or mechanical instability. Management options consist of either nonoperative or operative treatment, with the majority of the literature emphasizing operative management for chronic instability. Long-term studies assessing the different types of available operative repairs have now been published. This review article discusses chronic lateral ankle ligament instability from a functional, anatomical point of view. The indications for treatment, nonoperative and operative treatment, as well as the biomechanical information available regarding these methods of treatment are considered. The major emphasis of this review is discussion and analysis of the many different surgical treatment options. Following this review, we presently recommend anatomical repair to the bone of both the anterior talofibular ligament and the calcaneofibular ligament, together with imbrication of the ligaments. In patients with hypermobility, long-standing instability, or arthritis, reconstruction using the Chrisman-Snook technique is recommended.

Chronic Lateral Ankle Instability and Associated Conditions: A Rationale for Treatment

2007 ◽  
Vol 28 (10) ◽  
pp. 1041-1044 ◽  
Author(s):  
Joseph E. Strauss ◽  
Jonathan Agner Forsberg ◽  
Frederick G. Lippert
Keyword(s):  
Ankle Instability ◽  
Initial Time ◽  
Associated Injuries ◽  
Varus Alignment ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Lateral Ankle Ligament ◽  
Associated Conditions

Background: Ankle sprains have a high incidence of associated injuries and conditions that may be unrecognized at the initial time of injury. Failure to treat these conditions at the index surgery may compromise outcomes and delay recovery. The purpose of this study was to determine the type and frequency of associated injuries and conditions in military patients with chronic lateral ankle instability. Methods: Between 1996 and 2002, 160 patients had 180 modified Broström-Gould lateral ankle ligament reconstructions for chronic ankle instability. A retrospective review of the clinical history, physical examination, radiographs, and intraoperative findings was conducted. Results: The overall incidence of associated extra-articular conditions and injuries found in this study was 64%; 115 conditions were identified in 180 ankles. Peroneal tendon injuries occurred with the highest frequency (28%), followed by os trigonum lesions (13%), lateral gutter ossicles (10%), hindfoot varus alignment (8%), anterior tibial spurs (3%), and tarsal coalitions (2%). Twenty revision lateral ankle ligament reconstructions were required for either persistent pain or recurrent instability. The most common associated conditions were undiagnosed hindfoot varus alignment abnormalities (28%) followed by untreated peroneal injuries (25%). Conclusions: This study confirms the frequency of conditions associated with lateral ankle instability and emphasizes several conditions that have received little attention in the literature. Identifying these associated conditions before surgery enables the surgeon to treat all conditions at one operation, returning the patient to full activity sooner. Guidelines are presented to assist clinicians in screening patients for these associated conditions.

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