SLR - December 2023 - Berberich
Title: Arthroscopic vs. open Broström-Gould for repairing anterior talofibular ligament: mid-term outcomes comparison.Reference: Wang J, Tang Z, Sun H, Lv J, Jiang H, Yue Y. Arthroscopic vs. open Broström-Gould for repairing anterior talofibular ligament: mid-term outcomes comparison. Front Surg. 2023 May 10;10:1181493.
Level of Evidence: IV
Scientific Literature Review
Reviewed By: Erich Berberich, DPM
Residency Program: University Hospitals, Cleveland, OH
Podiatric Relevance: Chronic lateral ankle instability remains a common condition treated by podiatrists. If conservative treatments fail, surgical repair is offered via the Broström-Gould procedure. Many surgeons elect to arthroscopically evaluate and treat comorbid pathology in the ankle joint before performing an open Broström-Gould procedure during the same operation, with consistent outcomes. Arthroscopic repair has been increasing in popularity, but studies to date rarely evaluate patient-reported outcomes over longer periods of time. If arthroscopic Broström-Gould procedure is demonstrated to be comparatively efficacious to open repair, surgeons may feel confident in performing the entire procedure arthroscopically, sparing the patient from an additional incision.
Methods: Level IV retrospective cohort study was performed on all patients who underwent surgical repair of their ATFL at the author’s hospital between June 2014 and June 2018. Ninety-nine patients who underwent Broström-Gould with either arthroscopic (49) or open (50) technique were identified to have met the inclusion criteria. AOFAS scores and Karlsson-Peterson (K-P) scores were assessed preoperatively and at 6, 12, 24, and 48 months postoperatively. Visual analog scale (VAS) scores, manual anterior drawer test (ADT), and Tegner activity scores were evaluated preoperatively and at 48 months postoperatively. Secondary outcomes included surgery duration, hospitalization time, and postoperative complications.
Results: At final follow-up (24 months), all clinical outcomes were significantly improved relative to pre-operative values for both techniques. The arthroscopic group had higher AOFAS and K-P scores at 6 months, but this leveled out again at 12 and 24 months. Comorbid conditions such as ankle joint synovitis, osteophytes, and osteochondral defects (OCDs) did not differ between groups. Synovitis and osteophytes were debrided while OCDs were treated my microfracture. The arthroscopic group experienced 8 postoperative complications (6 SPN injuries and 2 superficial wound infections) while the open group had 7 complications (2 SPN injuries and 5 superficial wound infections). Although these complications were not statistically significantly different, it is worth noting that more SPN injuries occurred in the arthroscopic group while more superficial wound infections occurred in the open group, as expected. There was no significant difference in surgery duration or hospitalization time between groups.
Conclusions: This study demonstrates that the arthroscopic Broström-Gould technique is a comparatively effective treatment option compared to the well-established open technique for chronic lateral ankle instability with a minimum follow-up out to 48 months. Many studies have demonstrated superior outcomes from arthroscopic techniques in the short term postoperative period (6 weeks to 6 months), but few have demonstrated their effectiveness over longer periods of follow-up with larger sample sizes. This study improved my perception of the arthroscopic Broström-Gould and as a result, I am more likely to pursue training in this technique to be able to offer it to my patients. As one might expect, SPN injuries were the most common complication in the arthroscopic group, while wound infections were more common in the open group. This presents another reminder to transilluminate the SPN before creating the anterolateral ankle portal. This study was limited by its retrospective nature, as well as isolated repair of the ATFL without CFL repair. Postoperative assessment was essentially based on functional outcome measures, with little objective quantitative data. Treatment of comorbid ankle pathology could have been a confounder.