Return to Sport After Primary Lateral Ligament Repair vs. Suture Tape Augmentation: Meta-Analysis

Abstract

To analyze return to sport (RTS) following primary lateral ankle ligament repair compared to lateral ankle ligament reconstruction with suture tape augmentation in patients with chronic lateral ankle instability. Following the PRIMSA criteria, a systematic literature review and meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947-3/30/2018). Manuscripts that were duplicate, non-lateral ligament repair or reconstruction, biomechanical studies and published in a non-English language were excluded. Surgical techniques were evaluated in each reviewed study and subdivided by the following categories: primary repair (PR) and reconstruction with graft and suture tape augmentation (STA). A primary outcome of mean RTS was analyzed. 9 out of 1,844 identified studies met the criteria for final analysis. Mean weeks to RTS was reported in a total of 359 patients. One study reported RTS for the STA technique, which included 34 patients. Eight studies reported on primary lateral ankle ligament repair, representing 325 patients. Results were significant when comparing weighted means for PR and STA, with a shorter RTS of 10.7 weeks in the STA group compared with 16.4 weeks in the PR group (p < 0.001). This result, however, should be viewed with caution because of small sample size with STA compared to the larger proportion of patients undergoing PR. Excellent outcomes were noted in each intervention groups. STA appears to be significantly superior for patients when RTS is the primary outcome measure. Even with these promising results from STA, more studies are needed to further evaluate long-term patient outcomes of this surgical technique.