All-arthroscopic reconstruction of the anterior talofibular ligament is comparable to open reconstruction: a systematic review

Abstract

The aim of this study was to determine whether all-arthroscopic repair would lead to improved clinical outcomes, lower complication rates, shorter postoperative immobilization and earlier return to activity compared to open Broström repair in the surgical treatment of chronic lateral ankle instability (CLAI). A systematic literature search was conducted using Pubmed and Embase to identify studies dealing with a comparison of outcomes between all-arthroscopic and open Broström repair for CLAI. The search algorithm was 'ankle instability' AND 'Brostrom' AND 'arthroscopic' AND 'open'. The study had to be written in English language, include a direct comparison of all-arthroscopic and open Broström repair to treat CLAI and have full text available. Exclusion criteria were former systematic reviews, biomechanical studies and case reports. Overall, eight studies met the inclusion criteria and were included in the analysis. Clinical outcomes did not differ substantially between patients treated with either arthroscopic or open Broström repair. Studies that reported on return to activity and sports following surgery suggested that patients that had all-arthroscopic Broström repair returned at a quicker rate. Overall complication rate tended to be lower after arthroscopic Broström repair. Similar to open repair, all-arthroscopic ligament repair for CLAI is a safe treatment option that yields excellent clinical outcomes. Level of Evidence: Level III evidence (systematic review of level I, II and III studies).

Keywords: Broström; ankle arthroscopy; chronic lateral ankle instability.

Figure 1

PRISMA flow diagram of the identification of relevant studies.

Figure 2

Results of aggregate analysis for the comparison of AOFAS scores between AI and O groups. IV, inverse variance.

Figure 3

Results of aggregate analysis for the comparison of total VAS scores between AI and O groups. IV, inverse variance.

Figure 4

Results of aggregate analysis for the comparison of Karlsson scores between AI and O groups. IV, inverse variance.

Figure 5

Results of aggregate analysis for the comparison of overall complication rates between BR and ST groups. Numbers for ‘events’ refer to failure; numbers for ‘total’ refer to total participants. M–H, Mantel–Haenszel method.

Figure 6

Results of aggregate analysis for the comparison of rates for irritation of woundhealing between BR and ST groups. Numbers for ‘events’ refer to failure; numbers for ‘total’ refer to total participants. M–H, Mantel–Haenszel method.

Figure 7

Results of aggregate analysis for the comparison of rates for irritation of peroneal nerve and tendons between BR and ST groups. Numbers for ‘events’ refer to failure; numbers for ‘total’ refer to total participants. M–H, Mantel–Haenszel method.

Figure 8

Results of aggregate analysis for the comparison of knot pain rates between BR and ST groups. Numbers for ‘events’ refer to failure; numbers for ‘total’ refer to total participants. M–H, Mantel–Haenszel method.