SLR - January 2019 - Mallory Schweitzer

Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review

Reference: Brown AJ, Shimozono Y, Hurley ET, Kennedy JG. Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review. Arthroscopy. 2018 Aug;34(8):2497–2503.

Scientific Literature Review

Reviewed By: Mallory Schweitzer, DPM
Residency Program: Franciscan Foot & Ankle Institute, Federal Way, WA

Podiatric Relevance: Lateral ankle instability is a common pathology encountered by podiatric physicians. The anterior talofibular ligament and calcaneofibular ligament become attenuated due to single or multiple ankle sprains and are insufficient to stabilize the lateral ankle. Open repair using the Broström-Gould technique or the modified Broström-Gould technique has been described as the gold standard when the quality of the soft tissue is sufficient to support this type of repair. Arthroscopic lateral ankle stabilization has become more popular within recent years after being originally described by Hawkins in 1987. This study systematically reviewed and evaluated the current evidence on arthroscopic lateral ankle ligament repair techniques.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform a systematic review. A search was performed to identify relevant studies on PubMed/MEDLINE, EMBASE and Cochrane database. Included studies met the following criteria: therapeutic clinical studies, minimum 12-month follow-up, pre- and postoperative outcomes scores, publication in a peer-reviewed journal and published in English. Review articles, case reports, technique articles, cadaveric studies, animal studies and in vivo basic science studies were excluded. The Level of Evidence (LOE) and Quality of Evidence (QOE) for each study were assessed.

Results: Five hundred one studies were identified through the electronic search, and eight of these studies met the inclusion criteria. These studies included a total of 269 ankles with a weighted mean follow-up of 20.7 months. The LOE was I, III or IV, and the QOE was either fair or poor quality. The overall complication rate was 11.5 percent, and this was relatively high compared to other studies that have assessed the rate of complications following arthroscopic repair. Three studies compared arthroscopic versus open procedures and found no difference in complication rates. Neuritis was the most common complication. In the four studies that reported revision data, there was a weighted mean revision rate of 0.9 percent.  

Conclusions:
While arthroscopic lateral ankle ligament repair yielded favorable clinical outcomes in the short term, there was no difference in outcomes over a longer time period. There is a lack of long-term studies comparing these two methods. Several authors have reported a high incidence of intra-articular ankle pathology associated with lateral ankle instability and state that arthroscopic assessment of the joint is a valuable adjunct when performing a lateral ankle stabilization. As the complications described are mostly associated with arthroscopic portal placement, it is reasonable to perform an arthroscopic stabilization if an ankle arthroscopy is also planned. 

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