Clinical Outcomes of Anatomical Reconstruction of the Lateral Ankle Ligament Complex: A Systematic Review

Category: Ankle; Sports Introduction/Purpose: Anatomical reconstruction has gained increased attention in recent years and is indicated for patients with poor-quality ligaments, previously failed lateral ligament repair, generalized ligamentous laxity, or in patients with a high BMI. The purpose of this systematic review was to evaluate the current literature on anatomical reconstruction of the lateral ligaments in the treatment of chronic ankle instability. Methods: A systematic search of Pubmed, EMBASE and Cochrane Library databases was performed during October 2019. The studies included were carefully evaluated with regard to level of evidence (LOE) and quality of evidence (QOE), clinical and radiological outcomes, complications, revision rates and return to sport. Results: Thirteen studies including a total of 296 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. Within the autograft group, the AOFAS improved from 66.9 to 95.9, KPSSAF scores improved from 48 to 92.2, VAS scores improved from 6.8 to 0.2 at a follow up of 33.5 months, and the complication rate was 7.7%. Within the allograft group the AOFAS improved from 53.7 to 89.3, KPSSAF scores improved from 42.8 to 90.4, VAS scores improved from 7.3 to 1.9, and the complication rate was 7%. The overall rate of return to sport was 89%. Conclusion: The current systematic review demonstrated favorable results for both autograft and allograft reconstruction techniques in the treatment of chronic ankle instability. On comparing autograft and allograft techniques, minor differences were found both clinically and radiologically, with no overall evidence supporting one technique over the other

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Fair evidence consistently supports open surgical treatment for chronic ankle instability: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2018-000265 ◽

2019 ◽

Vol 4 (5) ◽

pp. 254-269

Author(s):

Chad Alexander Purcell ◽

James Calder ◽

Kentaro Matsui ◽

Pontus Andersson ◽

Jón Karlsson ◽

...

Keyword(s):

Systematic Review ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Systematic Evaluation ◽

Anatomical Reconstruction ◽

Lateral Ligament ◽

Anterior Talofibular Ligament ◽

Reconstruction Technique ◽

Operative Techniques ◽

Level Of Evidence

ImportancePatients with chronic ankle instability (CAI) who have failed non-operative treatments are most commonly treated with open ankle repair or reconstruction of the anterior talofibular ligament and/or calcaneofibular ligament. Over 50 operative techniques have been described for the treatment of CAI. However, there is no current systematic evaluation of currently used open operative techniques for the treatment of CAI.Aim/ObjectiveThe primary objective of this study is to provide evidence-based treatment recommendations for CAI in adults based on a comprehensive systematic review of the literature.Evidence reviewThe literature review of PubMed, EMBASE, Cochrane and Web of Science databases was completed on 22 February 2017. Search terms included two concepts: lateral ligament of the ankle (patients) and open reconstructive or repair procedures (intervention). All published clinical studies with English translation were included. Biomechanical, cadaveric, review articles, minimally invasive procedures and arthroscopic procedures were excluded. Open operative procedures from included articles were classified as anatomical or non-anatomical and repair or reconstructive. Articles were then assigned a level of evidence (I-V) to denote quality of the research methods. Articles were reviewed collectively to provide a grade of recommendation (A-C or I) in support for or against the operative intervention in treatment of CAI.FindingsSeventy one of 1635 identified articles were included for review. There is fair evidence (Grade B) in support of anatomical repair, anatomical reconstruction and non-anatomical reconstruction procedures. There was insufficient evidence available to grade internal brace and non-anatomical repair procedures.Conclusions and relevanceAlthough only fair-quality evidence exists in support of open operative treatment of CAI, this systematic review helps reassure clinicians of their current practices. The literature reaffirms support for open anatomical repair and anatomical reconstruction technique for CAI.Level of evidenceLevel II, systematic review.

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Arthroscopic Lateral Ligament Repair for Treatment of Chronic Ankle Instability: A Systematic Review

Benha Medical Journal ◽

10.21608/bmfj.2021.141715 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Amr Younis ◽

Emad Eldin Esmat ◽

Mohamed Singer

Keyword(s):

Systematic Review ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Lateral Ligament ◽

Ligament Repair

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Return to Sport After Proximal Hamstring Tendon Repair: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119853218 ◽

2019 ◽

Vol 7 (6) ◽

pp. 232596711985321 ◽

Cited By ~ 3

Author(s):

John W. Belk ◽

Matthew J. Kraeutler ◽

Omer Mei-Dan ◽

Darby A. Houck ◽

Eric C. McCarty ◽

...

Keyword(s):

Systematic Review ◽

Surgical Intervention ◽

Return To Sport ◽

Hamstring Tendon ◽

Activity Level ◽

Return To Play ◽

Rate Of Return ◽

Cochrane Library ◽

Level Of Evidence ◽

Proximal Hamstring

Background: Previous studies have evaluated functional outcomes and return-to-sport rates after proximal hamstring tendon (HT) repair. Purpose: To systematically review the literature in an effort to evaluate return-to-sport rates after proximal HT repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that evaluated postoperative lower extremity function and return-to-sport rates in patients after proximal HT repair. Search terms used were “hamstring,” “repair,” “return to sport,” and “return to play.” Patients were assessed based on return to sport, return to preinjury activity level, type of HT tear (complete or partial), and interval from injury to surgery. Patients were also divided into subgroups depending on timing of the surgical intervention: early, <1 month; delayed, 1 to 6 months; and late, >6 months from the time of injury. Results: Sixteen studies (one level 2, five level 3, ten level 4) met the inclusion criteria, including 374 patients with a complete proximal HT tear (CT group) and 93 patients with a partial proximal HT tear (PT group), with a mean follow-up of 2.9 years. Overall, 93.8% of patients (438/467) returned to sport, including 93.0% (348/374) in the CT group and 96.8% (90/93) in the PT group ( P = .18). The mean time to return to sport was 5.7 months, and 83.5% of patients (330/395) returned to their preinjury activity level. The early group demonstrated the greatest rate of return to sport at 94.4% (186/197) as well as the quickest time to return at a mean of 4.8 months, although this was not found to be statistically significant. Conclusion: Over 90% of patients undergoing repair of a complete or partial proximal HT tear can be expected to return to sport regardless of the tear type. Early surgical interventions of these injuries may be associated with a quicker return to sport, although the rate of return to sport does not differ based on timing of the surgical intervention.

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Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability: A systematic review

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.05.315 ◽

2018 ◽

Vol 24 (1) ◽

pp. 11-18 ◽

Cited By ~ 55

Author(s):

Matteo Guelfi ◽

Marco Zamperetti ◽

Andrea Pantalone ◽

Federico G. Usuelli ◽

Vincenzo Salini ◽

...

Keyword(s):

Systematic Review ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Lateral Ligament ◽

Ligament Repair

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Return to Sport After ACL Reconstruction With a BTB Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120964919 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096491

Author(s):

Matthew W. DeFazio ◽

Emily J. Curry ◽

Michael J. Gustin ◽

David C. Sing ◽

Hussein Abdul-Rassoul ◽

...

Keyword(s):

Systematic Review ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meta Analysis ◽

Return To Sport ◽

Hamstring Tendon ◽

Cochrane Library ◽

Level Of Evidence ◽

Patient Reported ◽

Primary Acl Reconstruction

Background: Anterior cruciate ligament (ACL) tears are debilitating injuries frequently suffered by athletes. ACL reconstruction is indicated to restore knee stability and allow patients to return to prior levels of athletic performance. While existing literature suggests that patient-reported outcomes are similar between bone–patellar tendon–bone (BTB) and hamstring tendon (HT) autografts, there is less information comparing return-to-sport (RTS) rates between the 2 graft types. Purpose: To compare RTS rates among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft. Study Design: Systematic review; Level of evidence, 4. Methods: The MEDLINE, Embase, and Cochrane Library databases were searched, and studies that reported on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Studies that utilized ACL repair techniques, quadriceps tendon autografts, graft augmentation, double-bundle autografts, allografts, or revision ACL reconstruction were excluded. RTS information was extracted and analyzed from all included studies. Results: Included in the review were 20 articles investigating a total of 2348 athletes. The overall RTS rate in our cohort was 73.2%, with 48.9% returning to preinjury levels of performance and a rerupture rate of 2.4%. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 81.0%, with 50.0% of athletes returning to preinjury levels of performance and a rerupture rate of 2.2%. Patients after primary ACL reconstruction with an HT autograft had an overall RTS rate of 70.6%, with 48.5% of athletes returning to preinjury levels of performance and a rerupture rate of 2.5%. Conclusion: ACL reconstruction using BTB autografts demonstrated higher overall RTS rates when compared with HT autografts. However, BTB and HT autografts had similar rates of return to preinjury levels of performance and rerupture rates. Less than half of the athletes were able to return to preinjury sport levels after ACL reconstruction with either an HT or BTB autograft.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211015207 ◽

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.

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Effectiveness of balance training in patients with chronic ankle instability: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-053755 ◽

2021 ◽

Vol 11 (9) ◽

pp. e053755

Author(s):

Ju Wang ◽

Di Zhang ◽

Tianyu Zhao ◽

Jiang Ma ◽

Song Jin

Keyword(s):

Systematic Review ◽

Ankle Instability ◽

Meta Analysis ◽

Balance Training ◽

Chronic Ankle Instability ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Ankle Sprains ◽

China National Knowledge Infrastructure ◽

Lateral Ankle

IntroductionLateral ankle sprains are one of the most common musculoskeletal injuries. Up to 70% of individuals who sustain lateral ankle sprains develop chronic ankle instability (CAI). Balance training has been used in patients with CAI, but the evidence for its efficacy is inconsistent. This systematic review and meta-analysis aims to determine the short-term (end of the treatment period) and long-term (6 months after treatment) effectiveness of balance training for patients with CAI.Methods and analysisWe will search PubMed, EMBASE, the Cochrane Library, Ovid, EBSCO-host, Pedro, ClinicalKey, ScienceDirect, Springer, China National Knowledge Infrastructure, Technology Periodical Database (VIP), WanFang Data and China Biology Medicine for reports of randomised trials of balance training in patients with CAI, from inception to 1 October 2021. The language will be restricted to English and Chinese, and articles will be screened and collected by two reviewers independently. Dynamic balance and functional ankle instability are the primary outcomes of this study. Secondary outcomes include pain, ankle range of motion, ankle strength and health-related quality of life. Review Manager V.5.3 software will be used for meta-analysis, and stratification analysis will be conducted for study quality according to the Jadad score. Subgroup and sensitivity analyses will be conducted. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess confidence in the cumulative evidence. The protocol follows the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines.Ethics and disseminationEthical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publications.

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Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120915704 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091570

Author(s):

Eoghan T. Hurley ◽

Yoshiharu Shimozono ◽

Charles P. Hannon ◽

Niall A. Smyth ◽

Christopher D. Murawski ◽

...

Keyword(s):

Systematic Review ◽

Plantar Fasciitis ◽

Platelet Rich Plasma ◽

Cochrane Library ◽

Level Of Evidence ◽

Pain Scores ◽

Vas Scores ◽

American Orthopaedic ◽

Meta Analyses ◽

The Cochrane Library

Background: Plantar fasciitis is the most common cause of plantar heel pain. Several recent randomized control trials (RCTs) have been published comparing the use of platelet-rich plasma (PRP) and corticosteroids (CSs) for the treatment of plantar fasciitis. Purpose: To perform a systematic review of RCTs to compare whether PRP or CS injections result in decreased pain levels and improved patient outcomes in the treatment of plantar fasciitis. Study Design: Systematic review; Level of evidence, 1. Methods: Medline, EMBASE, and the Cochrane Library were screened according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify RCTs comparing PRP and CS injections for plantar fasciitis. The visual analog scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared between groups at 1, 1.5, 3, 6, and 12 months, where possible. Statistical analysis was performed using RevMan, and P < .05 was considered to be statistically significant. Results: A total of 9 RCTs were identified comparing 239 patients with PRP with 240 patients with CS injections. At the follow-up time points, including 1-1.5, 3, 6, and 12 months, there were statistically significant differences in VAS scores in favor of PRP ( P = .004, P < .00001, P < .00001, and P < .00001, respectively). At 1 and 3 months, there was no difference in AOFAS scores ( P = .76 and P = .35, respectively). However, at 6 and 12 months, there was a difference in AOFAS scores in favor of PRP ( P < .00001 and P < .00001, respectively). Conclusion: In patients with chronic plantar fasciitis, the current clinical evidence suggests that PRP may lead to a greater improvement in pain and functional outcome over CS injections.

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Peroneus brevis tendon injury in chronic ankle instability.

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1231 ◽

2021 ◽

Vol 15 (1) ◽

pp. 37-42

Author(s):

Rhavi Soares Daniel ◽

Joaquim Maluf Neto ◽

Auro Mitsuo Okamoto ◽

Carlos Andrade

Keyword(s):

Ankle Instability ◽

Epidemiological Data ◽

Tendon Injury ◽

Chronic Ankle Instability ◽

Ligament Injury ◽

Lateral Ligament ◽

Aofas Score ◽

Level Of Evidence ◽

Lateral Ligament Injury ◽

Peroneus Brevis

Objective: To compare the surgical outcome of patients with chronic lateral ligament injury of the ankle, with and without an associated peroneus brevis tendon injury. Methods: This retrospective comparative study was based on epidemiological analysis and the American Orthopedic Foot and Ankle Society (AOFAS) scores of patients diagnosed with chronic ankle instability who were treated surgically with the Broström-Gould technique. The medical records of 50 patients treated in an orthopedics service between January 2012 and January 2020 were analyzed. The patients were divided into two groups: those with and without a peroneus brevis tendon injury. The following data were also collected: sex, age, comorbidities, and AOFAS score in the pre- and postoperative period (between 90-120 days), as well as other epidemiological data. Results: Sixteen patients (32%), whose mean age was 43 years and 76% of whom were female, presented with a peroneus brevis tendon injury. The right side (54%) was more commonly affected. The main comorbidities were obesity (14%), slight pes cavus (12%), diabetes mellitus (4%) and depression (4%). The mean improvement in AOFAS score was 41 points. There was a marginal difference in final AOFAS score (p=0.03) between the groups. Conclusion: The Broström-Gould Technique proved effective for treating chronic lateral ligament injury regardless of an associated peroneus brevis tendon injury. However, the final postoperative results were significantly worse in patients with a peroneus brevis tendon injury than in those without one. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.

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