SLR - June 2016 - Duc Nguyen
Activity Level and Function After Lateral Ankle Ligament Repair Versus Reconstruction
Reference: Matheny LM, Jonhson NS, Liechti DJ, Clanton TO. Activity Level and Function After Lateral Ankle Ligament Repair Versus Reconstruction. Am J Sports Med. 2016 May;44(5):1301–8.
Scientific Literature Review
Reviewed By: Duc Nguyen, DPM
Residency Program: Wyckoff Heights Medical Center
Podiatric Relevance: Ankle sprains are one of the most common musculoskeletal injuries. They can lead to chronic ankle instability and persistent symptoms of pain if left untreated. Ligament repair utilizing Broström-Gould technique has been the gold standard for lateral ankle instability. When repair is contraindicated, an alternative option is necessary to effectively restore the lateral ankle stability. Ligament reconstruction utilizing allograft may be a safe option with similar strength and stiffness when compared to native ligaments. The author of this study hypothesized that patients who underwent lateral ankle ligament reconstruction when repair was not possible will have similar outcomes and revision rates when compared with patients who underwent lateral ankle ligament repair.
Methods: In the study, all patients underwent either a Broström-Gould repair or allograft reconstruction of the ATFL and/or the CFL by a single surgeon between September 2009 and February 2013. Patients were excluded from the study if <18 year of age or if they had previous or concurrent tibiotalar arthrodesis or arthroplasty. Patients were followed up with a questionnaire at a minimum of two years follow-up after surgery. The outcomes were measured utilizing Foot and Ankle Disability Index, American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, Lysholm score, Western Ontario and McMaster Universities Arthritis Index score 5, Short Form–12 Health Survey Physical Component Summary, Mental Component Summary scores, Tegner activity scale, Modified visual analog scales and modified Likert scale.
Results: Eighty-six patients met the inclusion criteria of the study. Sixty-one patients were in the repair cohort and 25 patients in the reconstruction cohort. No significant difference was seen in all of the scores measured between the two groups. Activity level and functional level also showed no significant difference, as well as patient satisfaction.
Conclusions: From the above result conclusion, it shows that there are no significant differences in the outcome if patients were to be treated with repair utilizing Broström-Gould or reconstruction with allograft, as both have similar results and patient satisfaction. If patients are unable to receive the “gold standard” of treatment, then an alternative option is available that will allow for similar results and outcome. The study does have limitations as sample sizes are small and treatment was performed by only a single surgeon.