A Comparison Between Arthroscopic and Open Surgery for Treatment Outcomes of Chronic Lateral Ankle Instability Accompanied by Osteochondral Lesions of the Talus

SLR - May 2020 - Tyler Reber

Reference: Xu C, Li M, Wang C, Liu H. A Comparison Between Arthroscopic and Open Surgery for Treatment Outcomes of Chronic Lateral Ankle Instability Accompanied by Osteochondral Lesions of the Talus. J Orthop Surg Res. 2020;15(1):113. Published 2020 Mar 20. doi:10.1186/s13018-020-01628-3

Scientific Literature Review

Reviewed By: Tyler Reber, DPM
Residency Program: Franciscan Health System-St. Francis Hospital – Federal Way, WA

Podiatric Relevance: Less invasive and minimal incision type approaches are gaining popularity in foot and ankle surgery. When examining the surgical repair of lateral instability, there are several comparative studies that have demonstrated similar clinical results between the arthroscopic approach to the open modified Brostrom approach. However, comparison of these two surgical techniques has not been well studied when patients also undergo repair of an osteochondral lesion of the talus (OLT). The authors hypothesis was that the outcome of the all-arthroscopic surgery would have similar results to that of the combined open and arthroscopic surgery for treating chronic lateral ankle instability accompanied by OLT.

Methods: This was a retrospective study out of China where included patients were diagnosed with chronic lateral ankle instability accompanied by a OLT and were surgically treated between May of 2015 to May of 2017. A total of 67 patients where included, with 32 patients in the all-arthroscopic group and 35 patients in the combined group. The Karlsson Ankle Functional Score, visual analog scale (VAS) score, Tegner activity score, and the American Orthopaedic Foot & Ankle Society (AOFAS) score were used to evaluate and compare the two groups. The satisfaction and complication rate were also compared between the two groups. 

Results: With a minimum follow up of 24 months, both groups had statistically significant improvements in the functional outcomes for the preoperative to postoperative results. Nevertheless, there was no statistically significant difference when comparing the two groups to each other for the Karlsson Ankle Functional Score, VAS, Tegner activity score and the AOFAS. There was also no difference in the two groups in the satisfaction and complication rates. 

Conclusions: This study demonstrated that the outcome of the all-arthroscopic intervention was equivalent to that of the combined open and arthroscopic surgery. With no evidence validating one surgical technique over the other the decision on which surgical procedure to choose should come down to surgeon preference. With both surgical techniques being a viable option the surgeon should aim to select the procedure that will allow them to limit the amount of time in the OR and the technique they are more comfortable with as this may affect the patients outcome more then the surgical approach. This study only examines the long-term results of the surgery as the questionnaire was only performed preoperatively and at 24 months post operatively. Further studies are needed to determine if either surgical technique is more beneficial in the immediate postoperative phase.