SLR - January 2023 - Nicole Marie Smith, DPM
Title:Modified Brostrom-Gould surgical procedure for chronic lateral ankle instability compared with other operations: a systematic review and meta-analysis
Reference:
Yang Q, Liu J, Liu C, Zhou P, Zhu D. Modified Brostrom-Gould surgical procedure for chronic lateral ankle instability compared with other operations: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2022;23(1):981. Published 2022 Nov 12. doi:10.1186/s12891-022-05957-8
Level of Evidence: I
Scientific Literature Review
Reviewed By:
Nicole Marie Smith, DPM
Residency Program:
SSM Health DePaul Hospital – Bridgeton, MO
Podiatric Relevance:
Ankle sprains can be difficult sports injuries to treatment with over half of patients experiencing chronic lateral ankle instability (CLAI). These traumatic injuries can lead to long term pathology including talar cartilage injury and early ankle osteoarthritis. The authors inquired whether other operations can achieve better outcomes than Modified Brostrom-Gould (MBG) the current gold standard in treating CLAI.
Methods:
This level I systematic review utilized PubMed, Cochrane and EMBASE to identify randomized controlled trials (RCTs) evaluating the clinical outcomes of other surgical operations versus MBG in the treatment of CLAI.
Inclusion criteria of the RCTs involved studies that were randomized, double blind, placebo-controlled trials. Further criteria included studies with either Ankle Outcome Score (FAOS), ankle joint stability or complications noted. Additionally, identified studies needed to have the articles available in full text for analysis. Exclusion criteria included studies with patients who have had any prior ankle surgery, studies with more than 20% of patients lost to follow-up and studies without full texts available for review. Ultimately eight randomized controlled trials published between 1994 and 2021 with a minimum one-year follow-up time were included. A total of 426 CLAI patients with 222 receiving other operations and 205 receiving MBG treatment were identified in this meta-analysis. Clinical outcomes considered were pain symptoms, activities of daily living (ADLs), sport, quality of life (QOL) and total FAOS scores. Additionally, this meta-analysis also reviewed post-operative complications.
Results:
Of the eight RCTs included, six outcome indicators were measured including: pain, symptoms, ADLs, sport, QOL and total FAOS scores. For both pain symptoms and sport, patients who underwent other operations had better overall clinical pain scores. Authors accredit these difference in FAOS scores due to use of tendons or suture tape repairs to mimic torn ligament’s physiological role leading to enhanced ankle stability. For ADLs, the scores between MBG and other operations were not statistically significant. In measuring QOL and total FAOS score, there was considerable scoring difference with the other operations group fairing better than MBG groups according to the pooled data. Overall, among the six outcome indicators, in terms of FAOS scores, the other operations group appeared to have an advantage with a reported 6.53 points higher than MBG group. Authors also analyzed four post-operative complications (infection, recurrence, irritation and nerve injury) and identified no statistical significance between the two groups.
Conclusions:
Results of this study reveal no significant differences between other operations and MBG operations group regarding post-operative ankle stability or complications. In measuring clinical advantages including pain symptoms and sport, patients who underwent other operations had better outcomes than those in the MBG surgery group. In treating CLAI, other suitable surgical methods should be considered in addition to MBG- which remains the present gold standard treatment. Albeit this is the first meta-analysis to incorporate recent randomized controlled trials in evaluating both MBG and many procedures, this study is not conclusive. Future research with high-quality RCTs with additional sample numbers would be beneficial in demonstrating this study’s results.