2017 ISAKOS Biennial Congress ePoster #102

 

Anatomic Versus Non-Anatomic Reconstruction for Chronic Lateral Ankle Ligament Instability

Sam Si-Hyeong Park, MD, Toronto, Ontario CANADA
Corey Sermer, MSc, Toronto, Ontario CANADA
Johnny T Lau, MD, MSc, FRCSC, Toronto, Ontario CANADA
Christopher Kim, MD, MSc, FRCSC, Toronto, Ontario CANADA
Andrea N. Veljkovic, MD, MPH, FRCSC, BComm CANADA

University of Toronto, Division of Orthopaedic Surgery, Toronto, Ontario, CANADA

FDA Status Not Applicable

Summary

Anatomic reconstructions for chronic lateral ankle instability resulted in superior subjective clinical outcomes and lower complication rates compared to non-anatomic techniques.

ePosters will be available shortly before Congress

Abstract

Introduction

Numerous case series have reported good outcomes following both anatomic and non-anatomic lateral ankle ligament reconstructions. The few comparative studies (often involving small sample cohorts) have shown low quality evidence in favor of anatomic techniques. This study aimed to meta-analyze the available literature to compare clinical outcomes following anatomic versus non-anatomic lateral ankle ligament reconstructions.

Methods

A computerized search of multiple electronic databases was conducted for all studies up to December 2015 involving anatomic and non-anatomic reconstructions for chronic lateral ankle ligament instability. Inclusion criteria were English-language publications with minimum average 2-year follow-up. Excluded were studies involving concomitant medial ankle instability, associated ankle or hindfoot fractures, patients with previous ankle or hindfoot surgery, skeletally immature patients, patients with connective tissue disorders, surgery for acute lateral ankle ligament injuries, and biomechanical studies. Clinical outcomes were evaluated using the Good outcome rating scale, Karlsson-Peterson score, Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot score, anterior drawer, talar tilt, and range of motion. Secondary outcome measures included complications due to failure (defined as re-rupture, recurrent instability, or re-operation), infection, neurologic injury, and subsequent arthritis. For each outcome measure, a combined weighted effect size was first calculated for each reconstruction group using a random effects model. Effect size difference between the two groups was then tested using chi-square test (for proportions) or t-test (for means).

Results

Ninety-five publications met inclusion and exclusion criteria, totaling 3,828 patients (2,502 anatomic, 1,326 non-anatomic). A total of 3,936 ankles (2,561 anatomic, 1,375 non-anatomic) were analyzed. Ankles with anatomic reconstructions had a higher proportion of excellent and good outcomes on the Good rating scale (0.89 versus 0.76, p<0.0001) and higher mean Karlsson-Peterson scores (90.3 versus 81.6, p=0.006) compared to ankles reconstructed by non-anatomic techniques. No differences were found between reconstruction groups for the AOFAS score, talar tilt, and anterior drawer. There was insufficient data to compare the FAOS scores and range of motion. With regards to complications, anatomic reconstructions resulted in lower rates of failure (0.03 versus 0.06, p<0.0001), neurologic injury (0.012 versus 0.119, p<0.001), and osteoarthritis (0.10 versus 0.20, p<0.0001), when compared to non-anatomic reconstructions. Infection rates were similar between the surgical groups (0.015 versus 0.019, p=0.461).

Discussion And Conclusion

Both anatomic and non-anatomic reconstructive procedures resulted in similar degrees of ankle stability based on objective measures. However, anatomic reconstructions yielded superior subjective clinical outcomes and lower complication rates when compared to non-anatomic techniques. These findings suggest that anatomic reconstructions may be the more favorable technique when surgically managing chronic lateral ankle instability.