SLR - November 2020 - Morgan E. Garcia
Reference: Brown AJ, Shimozono Y, Hurley ET, Kennedy JG. Arthroscopic Versus Open Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Meta-Analysis. Knee Surg Sports Traumatol Arthrosc. 2020 May;28(5):1611-1618.Level of Evidence: I
Scientific Literature Review
Reviewed By: Morgan E. Garcia, DPM
Residency Program: UF Health Jacksonville – Jacksonville, FL
Podiatric Relevance: The anterior talofibular ligament is the most frequently injured lateral ligament of the ankle, and statistics show at least 20% of ankle sprains lead to chronic lateral ankle instability, requiring surgical intervention. The open modified Broström-Gould procedure is widely accepted as the gold standard for surgical repair of the lateral ankle instability. In recent years, an arthroscopic lateral ankle ligament repair technique has become increasingly popular. The purpose of this study was to evaluate the current evidence and compare arthroscopic and open lateral ankle ligament repair techniques for chronic lateral ankle instability.
Methods: Two independent reviewers performed a systematic search of MEDLINE, EMBASE and Cochrane Library databases during February 2018. Included studies were evaluated with regard to level of evidence and quality of evidence using the Modified Coleman Methodology Score. Total number of patients, patient age, follow up time, gender ratio, surgical technique, surgical complications, complication rate, recurrent instability or revision rate, clinical outcome measures and percentage of patients who returned to sport at previous level were also evaluated. Statistical analysis was performed using RevMan, and a p value of <0.05 was considered to be statistically significant.
Results: Four studies met the inclusion and exclusion criteria for a total of 207 ankles with a mean follow up of 25.6 months. All four studies utilized suture anchors in both the open and arthroscopic repair techniques described. Functional outcomes were recorded via AOFAS scores and Karlsson score showing a significant difference in favor of the arthroscopic repair and no significant difference with regard to the latter. There was no statistically significant difference in total, nerve and wound complications.
Conclusions: The most important finding from the current study was that the arthroscopic ATFL repair is a safe and viable technique for restoring lateral ankle ligament instability. The current meta-analysis found that short-term AOFAS functional outcome scores were significantly improved with arthroscopic lateral ankle repair compared to open repair. There was no significant difference between arthroscopic and open repair with regards to Karlsson functional outcome score, total complication rate, or the nerve and wound complications. However, the individual studies included were unable to conclusively support the arthroscopic or open techniques due to the low quality of the included studies. The current evidence is still limited and further prospective trials with longer follow-up are needed.