Does arthroscopic repair show superiority over open repair of lateral ankle ligament for chronic lateral ankle instability: a systematic review and meta-analysis

Abstract

Background: There is still no definite consensus on whether arthroscopic repair shows superiority over open repair for chronic lateral ankle instability. We conducted a systematic review and meta-analysis of the current comparative studies to make a generalized analysis. Methods: PubMed, Embase, and Web of Science databases were searched from inception to April 2020. Included studies were assessed by the level of evidence and quality of evidence (Cochrane Handbook or MINORS). The process of data extraction was conducted by two independent authors. The comparative results of clinical outcomes, stress radiographic outcomes, and complication rates between two groups were pooled. Statistical analysis was performed using STATA. Results: Nine comparative studies for a total of 473 patients (250 arthroscopic repair, 223 open repair) were included. For the clinical outcomes, a significant difference was found in favor of arthroscopic repair with regard to AOFAS scores (MD 0.32, 95% CI 0.12 to 0.53, I 2 = 7.7%, P = .370) and VAS scores (MD − 0.30, 95% CI − 0.54 to − 0.05, I 2 = 48.3%, P = .102). No significant difference was found regarding to stress radiographic outcomes. Importantly, the total complication rate (RR 0.88, 95% CI 0.51 to 1.49, I 2 = 0%, P = .957) as well as nerve complication rate (RR 1.21, 95% CI 0.53 to 2.75, I 2 = 0%, P = .975) of arthroscopic repair group is not significantly different to that of open repair group. Conclusions: Arthroscopic repair for lateral ankle instability shows excellent clinical results comparable to open repair. Especially, arthroscopic repair might alleviate more pain due to the minimally invasive procedure. Patients receiving arthroscopic repair do not result in a higher total complication rate and nerve injury rate.

Fully Intra-articular Lasso-Loop Stitch Technique for Arthroscopic Anterior Talofibular Ligament Repair

“…4 Advancements with instruments and techniques in recent years have resulted in a higher spatial resolution for arthroscopic procedures compared with open ones. 2,17,19,20,26 These procedures were developed gradually from arthroscopy-assisted to all-inside arthroscopic techniques. Vega et al 23 reported that 16 patients with chronic lateral ankle instability were treated with an all-inside arthroscopic repair technique, with ankle stability restored in all cases without major complications.…”

“…Some series have indicated superior clinical results with arthroscopic techniques compared with open techniques and hold the potential to alleviate more pain due to the minimally invasive nature of the procedure. 1,20,21,26 However, compared with conventional open surgeries, arthroscopic procedures have more technological challenges and a higher complication risk. 1,16 For example, the risk of nerve entrapment is a primary concern.…”

Ankle and syndesmosis instability: consensus and controversies

“…As endoscopic skill became more universal, the ability to perform this procedure with the arthroscope is possible and reproducible with less aggression to the patients. The short-term clinical outcomes are better, 29 with no significant difference in complication rate, 29 , 30 so we can predict that in the future the recommended method for surgical treatment of CAI will be arthroscopic.…”

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair

“…The modified Broström procedure (repair of the anterior talofibular ligament and augmentation with the inferior extensor retinaculum, Fig. 1 ) is a standard procedure for CLAI patients who do not respond to three to six months of conservative management [ 4 – 6 ]. Patients with OLTs less than 15 mm in diameter are usually treated with intra-articular debridement and microfracture [ 1 , 7 ].…”