Summary

Six risk factors were identified and can be divided into three categories: patient factor (generalized joint laxity [GJL], high level of sporting activities and female gender), imaging assessment (varus hindfoot alignment) and surgical finding (poor quality of the remnant lateral ligaments and intraoperative syndesmosis widening)

Abstract

70% of patients with acute lateral ankle sprains may develop residual disabilities such as pain, swelling, recurrent sprains and chronic lateral ankle instability (CLAI), the latter represents one of the commonest complication, occurring in 40% of cases. The literature is lacking in the risk factors for failure of lateral ankle ligament repairs in CLAI. Understanding the cause for failure is difficult because accurate information is lacking and contradictory results are reported regarding specific risk factors for treatment failure. The purpose of this study is to identify, review and summarize risk factors for failure of CLAI. A systematic review was conducted following the PRISMA guidelines. In July 2023, a bibliographic search of the PubMed, Medline, CINAHL, Cochrane, and Embase databases was done. The search strategy used for PubMed, which was modified for other database, was as follows: using the MeSH terms: [(ankle repair OR Brostrom OR ankle reconstruction OR ankle ligament repair OR ankle ligament Brostrom OR ankle ligament reconstruction OR lateral ankle ligament repair OR lateral ankle ligament Brostrom OR lateral ankle ligament reconstruction OR ATFL repair OR ATFL Brostrom OR ATFL reconstruction OR ATFL CFL repair OR ATFL CFL Brostrom OR ATFL CFL reconstruction) AND (failure OR recurrence OR reinjury)] AND (English[Language]). Articles were included if they were quantitative studies published in English and reported risk factors for failure of lateral ankle ligament repair defined as recurrence of instability. A total of 496 articles were identified using the search strategy, and nine articles were included. All were low-quality cohort studies (level 3 or 4 evidence). These nine studies comprising of 762 participants met the criteria for inclusion. Eighty-nine patients (11%) had treatment failure as defined by recurrence of instability ranged from 5.7 % to 28.5%. Six risk factors were identified and can be divided into three categories: patient factor (generalized joint laxity [GJL], high level of sporting activities and female gender), imaging assessment (varus hindfoot alignment) and surgical finding (poor quality of the remnant lateral ligaments and intraoperative syndesmosis widening). The presence of one or more of these risk factors including GJL, high level of sporting activities, female gender, varus hindfoot alignment, poor quality of the remnant lateral ligaments and intraoperative syndesmosis widening during lateral ankle ligament repair for CLAI should influence the surgical strategy in order to mitigate risk of treatment failure.