Current Literature Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review

Abstract

Category: Ankle; Other Introduction/Purpose: Treatment for lateral ankle instability (LAI) varies drastically from conservative to operative management depending on the individual's injury, symptoms, and lifestyle. Typically, surgical treatment is recommended when conservative treatments fail for LAI. The importance of determining the most effective treatment is necessary due to LAI costing $2 billion annually within the health care system [1]. Furthermore, residual physical disability following failed treatment for LAI occurs in up to 70% of patients [2]. Unfortunately, despite exceedingly high incidences and economic impact, a standard definition of failure for the surgical treatment of LAI alludes clinicians and researchers. Therefore, the purpose of this project is to identify LAI treatment 'failure' definitions that are currently in the literature and work towards standardization of the definition. Methods: A systematic search of Medline, SportDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for lateral ankle instability and included information about surgical failures. Studies with level of evidence I to IV were included for this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinion were excluded. These studies were then reviewed for definitions of failure of any surgical procedure used to correct lateral ankle instability. Results: Of the 1,200 studies, 3.5% (42/1,200) studies published between 1984 and 2020 met inclusion criteria and were analyzed. After reviewing the data, numerous definitions were found in the literature for LAI surgical failure. The most common was 'recurrent instability' (40%, 17/42) followed by 're-rupture' (24%, 10/42). For the original operation, the Modified Brostrom Gould technique was used most frequently (40%, 17/42) in cases treated operatively. The failure rate of this procedure ranged from 1.1% to 45.2% depending on the definition of 'failure.' Conclusion: There were multiple definitions of failure for surgical treatment of lateral ankle instability and is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from a standardization of ankle instability treatment 'failure' definition. This definition should incorporate multiple facets, including history, physical examination findings, outcome scores, imaging, and surgical findings for an inclusive understanding of failure.