SLR - December 2021 - Megan Zainer
Reference: Deng, Xinchao, Man Zou, Hongfei Zhu, Changjun Zuo, Kunqing Li, & Liang Qian. "A Comparison of the Modified Broström Procedure and Modified Karlsson Procedure in Treating Chronic Lateral Ankle Instability: A Systematic Review and Meta-Analysis." Annals of Palliative Medicine, 10.7 (2021): 7534-7542.Level of Evidence: Level I
Scientific Literature Review
Reviewed By: Megan Zainer, DPM
Residency Program: Ascension Wisconsin – Milwaukee, WI
Podiatric Relevance: The ankle joint is the most commonly injured part of the human motion system, with the most vulnerable part being the lateral collateral ligaments. Most patients with ankle sprains achieve satisfactory results with conservative treatment. Roughly 20 percent of patient’s injuries gradually worsen with up to 40 percent presenting with symptoms of chronic lateral ankle instability. In 1964, Broström reported 60 cases of direct ligament repair with tightening and suturing of the joint capsule being found suitable for patients with CLAI. The Broström typically causes minimal trauma to the patient’s body, however in some cases there is difficulty in suturing remaining ligament to normal endpoint, and stability cannot be guaranteed long term. In 1988, Karlsson reported that the distal fibula could be repaired by an imbricate suture using a multi-drilling technique. One study of 152 patients who were followed for 2-10 years post-op with a rate of 87 percent in recovery reported.
Methods: Level I systematic review and meta-analysis was performed using nine randomized controlled studies with 643 patients to compare outcomes in those who underwent a Modified Broström or Modified Karlsson procedure for CLAI. The study used PubMed, EMBASE, Central Register of Cochrane Controlled Trials database and included studies between 2010 and 2018.
Results: Nine RCTs used for the meta-analysis included 643 patients. Three hundred twenty-three patients underwent Modified Karlsson procedure, and 320 patients underwent Modified Broström procedure. The difference between the AOFAS scores for the Karlsson and Broström groups were statistically significant with the Karlsson group being higher than those patients in the Broström group. Tegner scores for the 643 patients showed higher scores in the Karlsson group compared with the Broström group. The meta-analysis included 643 samples with data on operation time for all patients undergoing surgery to treat CLAI, with patients in the Broström group undergoing longer operative times. In regards to patient satisfaction levels, there was statistically significant difference, with the Karlsson group having higher levels of satisfaction than those in the Broström group. There was no significant difference observed in relation to surgery complications.
Conclusions: Clinical data from this study reveals more satisfactory results in regards to AOFAS scores, Tegner scores, and operative time in the Modified Karlsson procedure compared to a Modified Broström for CLAI. The AOFAS scores in the Modified Karlsson group were significantly lower than those in the Modified Broström pre-op, and post-operatively the AOFAS scores in the Modified Karlsson group were increased. The improved scores were significantly higher than those in the Broström group, which indicates Karlsson might be slightly better than the Broström treatment. Some believe the modified Karlsson is similar and easier than the modified Broström. The results show clinical effects of patients in the Karlsson group were better than those for patients in the Broström group, though the authors acknowledge their study could be improved with consideration of larger scale studies with additional updated articles.