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

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 Through Two Portals in Chronic Ankle Instability

The Open Orthopaedics Journal ◽

10.2174/1874325001711010617 ◽

2017 ◽

Vol 11 (1) ◽

pp. 617-632 ◽

Cited By ~ 6

Author(s):

Jorge Pablo Batista ◽

Jorge Javier del Vecchio ◽

Luciano Patthauer ◽

Manuel Ocampo

Keyword(s):

Ankle Instability ◽

Medical Condition ◽

Surgical Techniques ◽

Clinical Success Rate ◽

Chronic Ankle Instability ◽

Tilt Test ◽

Lateral Ligament ◽

Return To Sports ◽

Ligament Repair

Objectives:Injury to the lateral ligament complex of the ankle is one of the most common sports-related injury.Usually lateral ankle evolves with excellent clinical recovery with non surgical treatment, however, near about 30% develop a lateral chronic instability sequela.Several open and arthroscopic surgical techniques have been described to treat this medical condition.Material and Methods:Of the 22 patients who were treated; 18 males and 4 females, and aged from 17-42 years (mean 28 years).All patients presented a history of more than three ankle sprains in the last two years and presented positive anterior drawer and talar tilt test of the ankle in the physical examination.We perform an anterior arthroscopy of the ankle in order to treat asociated disease and then we performed“All inside¨lateral ligament repair through two portals (anteromedial and anterolateral) using an anchor knotless suture.Results:Clinical outcome evaluations were performed at a mean follow up of 25 months. (R: 17-31).Overall results has been shown by means of the American Orthopaedic Foot and Ankle Society (AOFAS). Mean AOFAS scores improved from 63 points (range 52–77) preoperatively to 90 points (range 73–100) at final follow up.No recurrences of ankle instability were found in the cases presented.Conclusion:Several surgical procedures have been described during the last years in order to treat chronic ankle instability.¨All inside¨lateral ligament reconstruction presents lower local morbidity than open procedures with few complications. Moreover, it is a reproductible technique, with high clinical success rate, few complications and relatively quick return to sports activities. A high knowledge of the anatomic landmarks should be essential to avoid unwated injuries.

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Arthroscopic ankle lateral ligament repair with biological augmentation gives excellent results in case of chronic ankle instability

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-019-05650-9 ◽

2019 ◽

Vol 28 (1) ◽

pp. 108-115 ◽

Cited By ~ 8

Author(s):

Guillaume Cordier ◽

Johan Lebecque ◽

Jordi Vega ◽

Miki Dalmau-Pastor

Keyword(s):

Ankle Instability ◽

Chronic Ankle Instability ◽

Lateral Ligament ◽

Ligament Repair ◽

Ankle Lateral Ligament ◽

Biological Augmentation

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00363 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0036

Author(s):

Conor Mulvin ◽

James P. Toale ◽

Kevin Rosas ◽

Eoghan T. Hurley ◽

John G. Kennedy

Keyword(s):

Systematic Review ◽

Complication Rate ◽

Ankle Instability ◽

Return To Sport ◽

Chronic Ankle Instability ◽

Anatomical Reconstruction ◽

Cochrane Library ◽

Lateral Ligament ◽

Level Of Evidence ◽

Vas Scores

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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Balance Training Does Not Alter Reliance on Visual Information during Static Stance in Those with Chronic Ankle Instability: A Systematic Review with Meta-Analysis

Sports Medicine ◽

10.1007/s40279-017-0850-8 ◽

2017 ◽

Vol 48 (4) ◽

pp. 893-905 ◽

Cited By ~ 3

Author(s):

Kyeongtak Song ◽

Evan Rhodes ◽

Erik A. Wikstrom

Keyword(s):

Systematic Review ◽

Visual Information ◽

Ankle Instability ◽

Meta Analysis ◽

Balance Training ◽

Chronic Ankle Instability

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Injury-Related Fear in Individuals With and Without Chronic Ankle Instability: A Systematic Review

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0015 ◽

2021 ◽

pp. 1-10

Author(s):

Ashley M.B. Suttmiller ◽

Ryan S. McCann

Keyword(s):

Systematic Review ◽

Ankle Sprain ◽

Methodological Quality ◽

Ankle Instability ◽

Evidence Synthesis ◽

Chronic Ankle Instability ◽

Fear Avoidance ◽

Physically Active ◽

Fear Avoidance Beliefs ◽

Fear Avoidance Beliefs Questionnaire

Context: Injury-related fear has recently been recognized to exist in ankle sprain populations. It is unclear, however, if injury-related fear levels differ between those who develop chronic ankle instability (CAI) and those who do not and the best tools for assessing these differences. Objective: The purpose of this study was to conduct a comprehensive systematic review investigating differences in injury-related fear between individuals with and without CAI. Evidence Acquisition: Relevant studies from CINAHL Plus with full text, PubMed, and SPORTDiscus through November 2020 were included. All studies used the Tampa Scale of Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, or Athlete Fear Avoidance Questionnaire as either a descriptor or a main outcome and provided comparison data between a CAI group and ankle sprain copers (COP) or controls (CON). The authors independently assessed methodological quality using the modified Downs and Black Quality Index. Studies were then grouped by between-group comparisons including CAI and CON, CAI and COP, and COP and CON. The authors calculated Hedge g effect sizes and 95% confidence intervals to examine group differences. Evidence Synthesis: A total of 11 studies were included in this review. In total, 8 studies provided data for the CAI and CON comparison, 7 for CAI and COP comparisons, and 4 for COP and CON comparisons. Methodological quality scores ranged from 60.0% to 86.7%, with 2 high-, and 9 moderate-quality studies. Overall, the evidence suggests that physically active individuals with CAI report higher levels of injury-related fear when compared with both COP and CON. Although limited, ankle sprain COP do not seem to differ from CON. Conclusion: Available evidence emphasizes the importance of injury-related fear in individuals who develop chronicity after ankle sprain injury. The Fear-Avoidance Beliefs Questionnaire and Tampa Scale of Kinesiophobia are useful for the identification of injury-related fear in individuals after sustaining an ankle sprain and should be used to inform rehabilitation strategies and to monitor efficacy in fear reduction.

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