Outcomes of Open Versus Arthroscopic Broström Surgery for Chronic Lateral Ankle Instability: A Systematic Review and Meta-analysis of Comparative Studies

Attia, Ahmed Khalil; Taha, Tarek; Mahmoud, Karim; Hunt, Kenneth J.; Labib, Sameh A.; D’Hooghe, Pieter

doi:10.1177/23259671211015207

Cited by 37 publications

(23 citation statements)

References 32 publications

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“…With recent advances in technology, surgeons are showing more interest in arthroscopic procedures, and their clinical outcomes are comparable to those of traditional open Broström procedures. 2 However, the recurrence of postoperative instability remains a major concern. 35 Although anatomic factors have been reported as risk factors for recurrent instability after lateral ankle ligament repair, 44 there is a lack of data in the literature delineating the risk factors, including activity level, remnant quality, and repair techniques.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair

et al. 2023

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Background: Arthroscopic anterior talofibular ligament (ATFL) repair is widely performed for chronic lateral ankle instability (CLAI). Although many studies have reported excellent outcomes with this procedure, the recurrence of instability remains a common concern. Therefore, this study aimed to analyze the risk factors for the recurrence of instability after arthroscopic repair for CLAI. Methods: Fifty-six ankles of 53 patients with a mean age of 31.8 ± 14.7 years were retrospectively reviewed. All patients underwent arthroscopic ATFL repair. If instability remained immediately after ATFL repair, calcaneofibular ligament (CFL) repair was performed. The Ankle Activity Score (AAS) was assessed preoperatively, and clinical outcomes including the Japanese Society for Surgery of the Foot scale, Karlsson-Peterson scores, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the final follow-up. Talar tilt angle (TTA) was assessed preoperatively and 1 year postoperatively. Ankles were divided into 2 groups—nonrecurrence (postoperative TTA, <6 degrees) and recurrence (postoperative TTA, ≥6 degrees)—and clinical outcomes were compared. Results: Sixteen ankles showed recurrent instability, whereas 40 did not. AAS, TTA, and social functioning in the SAFE-Q were significantly higher in the recurrence group than those in the nonrecurrence group preoperatively. In addition, the rate of poor ATFL remnant quality and the number of CFLs not repaired despite the preoperative injury diagnosis were significantly higher in the recurrence group than in the nonrecurrence group. Conclusion: Arthroscopic repair for ATFL and CFL deficiencies with preoperative high activity, poor remnant quality, and neglected CFL injury can result in the recurrence of instability. Appropriate surgical procedures to prevent the recurrence of instability should be selected for these ankles. Level of Evidence: Level IV, retrospective case series.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair

et al. 2023

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“…These results are approximately similar to the results of a systematic review performed by Guelfi et al, 15 which included a total of 505 patients and revealed mean scores of 90.1 for the AOFAS in the open Brostrom procedure group. The VAS score indicated good results, and the overall average scores of the 2 groups and treatment groups were lower than those of a systematic review performed by Attia et al 2 The total ROM scores in the control group declined significantly compared with the PRP group after 3 months ( P = .030) (Tables 2 and 3). However, the difference was not clinically relevant (4.6 degrees).…”

Section: Discussionmentioning

confidence: 62%

Efficacy of Platelet-Rich Plasma for Chronic Lateral Ankle Instability After Modified Broström-Gould surgery: A Randomized, Single-Blinded, Prospective Controlled Trial

Sabaghzadeh

Kurdkandi

Ebrahimpour

et al. 2023

Foot & Ankle Orthopaedics

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Background: Modified Broström-Gould (MBG) surgery is frequently used for chronic lateral ankle instability (CLAI). However, conventional postoperative management (CPOM) due to prolonged immobilization may have adverse effects on tendons, ligaments, and joints, causing stiffness. This prospective, randomized controlled trial aimed to determine outcomes among patients randomized to receive CPOM plus ultrasonography-guided triple injections of leukocyte-rich platelet-rich plasma (LR-PRP) compared to patients who receive only CPOM after MBG surgery. Methods: The present study included 40 patients with symptomatic CLAI who were candidates for the MBG surgery. The patients were randomized into 2 groups of 20, the control and PRP groups. In the PRP group, patients were injected with 3 doses of LR-PRP solution using ultrasonographic guidance. In the first injection, 2 mL of LR-PRP was injected near the injury site, and in the second and third injections, 4 mL of LR-PRP was injected in the tibiotalar joint. All patients received a short leg splint for 2 weeks, followed by 4 weeks in a walking boot. The primary outcome measure was the visual analog scale (VAS), and the secondary outcome measures were the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and ankle total range of motion (total ROM). The assessment was performed at baseline and 3 and 6 months after surgery. Results: The mean VAS and AOFAS scores improved significantly in both groups 6 months after surgery ( P < .001). However, the PRP group did not significantly improve in VAS or AOFAS scores compared with the control group. No clinically significant difference was observed between the 2 groups regarding the total ROM scores at month 3. Conclusion: The application of LR-PRP after MBG surgery did not show any superior clinical or functional improvement over CPOM. Level of Evidence: Level II, prospective randomized trial.

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“…Moreover, biomechanical studies found no significant difference in fixation strength between open procedure and ABG [12,13]. ABG had become the standard treatment for CAI, with a small incision, less invasiveness, shorter hospital stay, improved functional recovery, and concomitant intraarticular lesion treatment under arthroscopy [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Functional results of modified Mason–Allen suture versus horizontal mattress suture in the arthroscopic Broström–Gould procedure for chronic ankle instability

Liu

Chen

et al. 2022

J Orthop Surg Res

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Background The arthroscopic Broström–Gould procedure (ABG) gained particular attention among clinicians and researchers due to its high rate of satisfactory results. There is a lack of evidence regarding the differences in clinical outcomes for the various suture techniques. The purpose of this study was to compare the differences in clinical effect in patients treated with one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture for chronic ankle instability (CAI). Methods This retrospective cohort study examined CAI patients who underwent either one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture ABG between January 2018 and January 2020. Patients were divided into two groups based on the suture knot type used and the associated number of anchors. The operative time, surgical cost, Visual Analog Scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) Score, Karlsson Ankle Functional Score (KAFS), the rate of return to sports, complications, and measured biomechanical strength using standardized equipment were compared between groups. Results Sixty-four CAI patients were included (one-anchor modified Mason–Allen suture group n = 30, two-anchor horizontal mattress suture group n = 34). Compared to the two-anchor horizontal mattress suture group, the one-anchor modified Mason–Allen suture group had significantly shorter operative time (p < .001) and lower surgical cost (p < .001). There were no postoperative complications in the two groups, and no significant differences in the VAS, AOFAS, KAFS, and rate of return to sports in postoperative follow-up between the two groups at 1 and 2 years after surgery. There was no statistically significant difference in biomechanical strength anterior drawer test displacement (p > .05) between the one-anchor modified Mason–Allen suture and two-anchor horizontal mattress suture at 2 years after surgery. Conclusion ABG using a one-anchor modified Mason–Allen suture showed comparable clinical results to a two-anchor horizontal mattress suture in the treatment of CAI at intermediate-term follow-up time. However, one-anchor modified Mason–Allen suture may be a faster, simpler, cost-effective substitute technology. Level of evidence Level III, comparative study.

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Outcomes of Open Versus Arthroscopic Broström Surgery for Chronic Lateral Ankle Instability: A Systematic Review and Meta-analysis of Comparative Studies

Cited by 37 publications

References 32 publications

Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair

Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair

Efficacy of Platelet-Rich Plasma for Chronic Lateral Ankle Instability After Modified Broström-Gould surgery: A Randomized, Single-Blinded, Prospective Controlled Trial

Functional results of modified Mason–Allen suture versus horizontal mattress suture in the arthroscopic Broström–Gould procedure for chronic ankle instability

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