Summary
A meta-analysis of arthroscopic lateral ankle ligament repair procedures demonstrated no significant difference in clinical outcome scores between techniques that utilized IER reinforcement and those that involved repair of the ATFL without IER reinforcement
Abstract
Background
Ankle sprains are common musculoskeletal injuries and the lateral ligament complex, most notably the ATFL, is involved in 85% of cases. First line therapy is conservative, but up to 20% of ankle sprains will not resolve with conservative therapy and progress to chronic lateral ankle instability. Patients with chronic lateral ankle instability after failed conservative management often require surgical intervention. Various arthroscopic procedures have been introduced to restore lateral ankle stability. Some arthroscopic procedures involve repair of only the ATFL with suture anchors, while others involve a procedure similar to the modified Broström and utilize reinforcement with the inferior extensor retinaculum (IER). Studies directly comparing different arthroscopic techniques are limited.
Purpose
To compare clinical outcomes of patients receiving arthroscopic lateral ankle ligament procedures in which only the ATFL was repaired vs procedures involving IER reinforcement. We hypothesized that clinical outcomes would be superior in patients receiving IER reinforcement.
Methods
A systematic review per PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines was conducted. The final meta-analysis included 20 studies. To assess the relationship of type of surgical procedure (repair of only the ATFL or repair of the ATFL plus IER reinforcement) to reported clinical outcomes based on the American Orthopaedic Foot and Ankle Society (AOFAS) score, the Karlsson and Peterson Scoring System for Ankle Function (KAFS), and the Visual Analogue Score (VAS), we used the standardized mean difference (SMD) with a 95% confidence interval of preoperative to postoperative scores as an effect size. The method of random-effects model was used to calculate the overall summary estimates.
Results
This meta-analysis included 20 studies to compare clinical outcomes of arthroscopic procedures for lateral ankle instability. Accounting for year of the study, N of patients, mean age, time from injury to surgery, and follow-up period as potential confounders, the type of surgical procedure had no significant difference on the preoperative to postoperative SMD score of AOFAS (P.value=0.308), KAFS (P.value=0.736), and VAS (P.value=0.402).
Conclusion
There is no significant difference in clinical outcomes for patients receiving arthroscopic lateral ankle ligament surgery with repair of only the ATFL (without IER reinforcement) versus repair of the ATFL with IER reinforcement. Patients receiving either arthroscopic ankle procedure should achieve excellent functional outcomes.
Disclosures:
Military Identification: Benjamin C Murray, LT, MC, USN, NMRTCP
Non-research disclaimer: The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
Research Disclaimer: The views expressed in this abstract reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
Copyright Statement: I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.
Funding Acknowledgement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.