Open operative treatment of chronic ankle instability

Abstract

Category: Ankle Introduction/Purpose: Ankle sprains are one of the most common musculoskeletal injuries. Though most patients recover fully without intervention, 10-30% will develop chronic ankle instability and require conservative or surgical management. The aim of this article is to provide an evidence-based literature review and assessment of the quality of literature regarding open operative interventions for chronic ankle instability. Methods: A comprehensive evidence-based literature review of Pubmed, Embase, Cochrane and Web of Science databases, conducted March 9, 2016; and updated February 22, 2017 identified 1635 articles, of which, 71 were relevant in assessing the efficacy of common open operative interventions for treatment of chronic ankle instability. The open operative procedures described in included articles were classified into the following four main categories: Anatomic repair, Non-anatomic repair, Anatomic reconstruction and Non-anatomic reconstruction. The 71 studies were then assigned a level of evidence (I-V) to denote quality. They were then reviewed to provide a grade of recommendation (A-C, I) in support of or against the operative intervention in treatment of chronic ankle instability. Results: Among the open operative treatment options available for chronic ankle instability, there is good evidence (Grade A) in support of anatomic reconstructive procedures. There is fair evidence (Grade B) from level II and III studies in support of anatomic repair and non-anatomic reconstruction procedures. Insufficient evidence was available to grade internal brace and non-anatomic repair procedures. Conclusion: Good quality evidence exists in support of open operative treatment of chronic ankle instability. Future studies should aim to elucidate roles for each of the classifications of open operative intervention in specific circumstances and patient populations. Furthermore, with good evidence to support more traditional techniques for repair of chronic ankle instability, high quality studies should be conducted on more novel minimally invasive and arthroscopic operative techniques to assure equal efficacy and safety to open techniques summarized here.