Abstract
BackgroundThere is still no definite consensus on whether arthroscopic repair shows superiority over open repair for chronic lateral ankle instability. We conducted a systematic review and meta-analysis of the current comparative studies to make a generalized analysis.MethodsPubMed, Embase, and Web of Science databases were searched from inception to April 2020. Included studies were assessed by the level of evidence and quality of evidence (Cochrane Handbook or MINORS). The process of data extraction was conducted by two independent authors. The comparative results of clinical outcomes, stress radiographic outcomes, and complication rates between two groups were pooled. Statistical analysis was performed using STATA.ResultsNine comparative studies for a total of 473 patients (250 arthroscopic repair, 223 open repair) were included. For the clinical outcomes, a significant difference was found in favor of arthroscopic repair with regard to AOFAS scores (MD 0.32, 95% CI 0.12 to 0.53, I2 = 7.7%, P = .370) and VAS scores (MD − 0.30, 95% CI − 0.54 to − 0.05, I2 = 48.3%, P = .102). No significant difference was found regarding to stress radiographic outcomes. Importantly, the total complication rate (RR 0.88, 95% CI 0.51 to 1.49, I2 = 0%, P = .957) as well as nerve complication rate (RR 1.21, 95% CI 0.53 to 2.75, I2 = 0%, P = .975) of arthroscopic repair group is not significantly different to that of open repair group.ConclusionsArthroscopic repair for lateral ankle instability shows excellent clinical results comparable to open repair. Especially, arthroscopic repair might alleviate more pain due to the minimally invasive procedure. Patients receiving arthroscopic repair do not result in a higher total complication rate and nerve injury rate.
Highlights
There is still no definite consensus on whether arthroscopic repair shows superiority over open repair for chronic lateral ankle instability
The anterior talofibular ligament (ATFL) is the most frequently affected ankle lateral ligamentfollowed by the calcaneofibular ligament (CFL) [4,5,6,7]
The open modified Broström technique, first proposed in 1966, is an operative repair method for the lateral ankle ligaments when the ligament remnant is sufficient and the hindfoot alignment is good, and is widely regarded as the gold standard [10, 11]. This technique was modified by Gould in 1980 that reinforced the inferior extensor retinaculum (IER) after ATFL repair to strengthen ankle stability [12]
Summary
There is still no definite consensus on whether arthroscopic repair shows superiority over open repair for chronic lateral ankle instability. The open modified Broström technique, first proposed in 1966, is an operative repair method for the lateral ankle ligaments when the ligament remnant is sufficient and the hindfoot alignment is good, and is widely regarded as the gold standard [10, 11]. This technique was modified by Gould in 1980 that reinforced the inferior extensor retinaculum (IER) after ATFL repair to strengthen ankle stability [12]. There is still no definite consensus on which operative treatment shows overall or marked superiority over the other for chronic lateral ankle instability
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