Skip to main content
SpringerLink
Log in

Arthroscopic versus open repair of lateral ankle ligament for chronic lateral ankle instability: a meta-analysis

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this meta-analysis was to analyze the current comparative studies of arthroscopic and open techniques for lateral ankle ligament repair to treat chronic lateral ankle instability.

Methods

A systematic search of MEDLINE, EMBASE and Cochrane Library databases was performed during February 2018. Included studies were evaluated with regard to level of evidence and quality of evidence using the Modified Coleman Methodology Score. Total number of patients, patient age, follow-up time, gender ratio, surgical technique, surgical complications, complication rate, recurrent instability or revision rate, clinical outcome measures and percentage of patients who returned to sport at previous level were also evaluated. Statistical analysis was performed using RevMan, and a p value of < 0.05 was considered to be statistically significant.

Results

Four comparative studies for a total of 207 ankles were included. There was a significant difference in favor of arthroscopic repair with regard to AOFAS score, and there was no significant difference with regard to Karlsson score. There was a statistically significant difference in AOFAS score in favor of the arthroscopic repair (MD; 1.41, 95% CI 0.29–2.52, I2 = 0%, p < 0.05). There was no statistically significant difference in Karlsson score (MD; 0.00, 95% CI − 3.51 to 3.51, I2 = 0%, n.s.). There was no statistically significant difference in total, nerve, or wound complications.

Conclusions

The current meta-analysis found that short-term AOFAS functional outcome scores were significantly improved with arthroscopic lateral ankle repair compared to open repair. There was no significant difference between arthroscopic and open repair with regards to Karlsson functional outcome score, total complication rate, or the nerve and wound complication subsets with the included studies with at least 12 months of follow-up. However, the current evidence is still limited, and further prospective trials with longer follow-up are needed.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Acevedo JI, Mangone PG (2011) Arthroscopic lateral ankle ligament reconstruction. Tech Foot Ankle Surg 10:111–116

    Article  Google Scholar 

  2. Acevedo JI, Ortiz C, Golanó P, Nery C (2015) ArthroBrostrom lateral ankle stabilization technique: an anatomic study. Am J Sports Med 43:2564–2571

    Article  Google Scholar 

  3. Brown AJ, Shimozono Y, Hurley ET, Kennedy JG (2018) Arthroscopic repair of lateral ankle ligament for chronic lateral ankle instability: a systematic review. Arthroscopy. https://doi.org/10.1016/j.arthro.2018.02.034

    Article  PubMed  Google Scholar 

  4. Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10:2–11

    Article  CAS  Google Scholar 

  5. Cox JS (1985) Surgical and nonsurgical treatment of acute ankle sprains. Clin Orthop Relat Res 198:118–126

    Google Scholar 

  6. Giza E, Shin EC, Wong SE, Acevedo JI, Mangone PG, Olson K et al (2013) Arthroscopic suture anchor repair of the lateral ligament ankle complex: a cadaveric study. Am J Sports Med 41:2567–2572

    Article  Google Scholar 

  7. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  Google Scholar 

  8. Jakobsen RB, Engebretsen L, Slauterbeck JR (2005) An analysis of the quality of cartilage repair studies. J Bone Jt Surg Am 87:2232–2239

    Google Scholar 

  9. Karlsson J, Sancone M (2006) Management of acute ligament injuries of the ankle. Foot Ankle Clin 11:521–530

    Article  Google Scholar 

  10. Kitaoka H, Alexander I, Adelaar R, Nunley J, Myerson M, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353

    Article  CAS  Google Scholar 

  11. Li H, Hua Y, Li H, Ma K, Li S, Chen S (2017) Activity level and function 2 years after anterior talofibular ligament repair: a comparison between arthroscopic repair and open repair procedures. Am J Sports Med 45:2044–2051

    Article  Google Scholar 

  12. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34

    Article  Google Scholar 

  13. Lynch SA, Renström PA (1999) Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment. Sports Med 27:61–71

    Article  CAS  Google Scholar 

  14. Marx RG, Wilson SM, Swiontkowski MF (2015) Updating the assignment of levels of evidence. J Bone Jt Surg Am 7:97:1–2

    Article  Google Scholar 

  15. Matsui K, Burgesson B, Takao M, Stone J, Guillo S, Glazebrook M (2016) Minimally invasive surgical treatment for chronic ankle instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 24:1040–1048

    Article  Google Scholar 

  16. Matsui K, Takao M, Miyamoto W, Matsushita T (2016) Early recovery after arthroscopic repair compared to open repair of the anterior talofibular ligament for lateral instability of the ankle. Arch Orthop Trauma Surg 136:93–100

    Article  Google Scholar 

  17. O’Loughlin P, Murawkski C, Egan C, Kennedy J (2009) Ankle instability in sports. Phys Sportsmed 37:93–103

    Article  Google Scholar 

  18. Ramponi L, Yasui Y, Murawski CD, Ferkel RD, DiGiovanni CW, Kerkhoffs GMMJ et al (2017) Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review. Am J Sports Med 45:1698–1705

    Article  Google Scholar 

  19. Rigby RB, Cottom JM (2018) A comparison of the ‘All-Inside’ arthroscopic Broström procedure with the traditional open modified Broström–Gould technique: a review of 62 patients. Foot Ankle Surg. https://doi.org/10.1016/j.fas.2017.07.642

    Article  PubMed  Google Scholar 

  20. So E, Preston N, Holmes T (2017) Intermediate- to long-term longevity and incidence of revision of the modified Broström–Gould procedure for lateral ankle ligament repair: a systematic review. J Foot Ankle Surg 56:1076–1080

    Article  Google Scholar 

  21. Yasui Y, Murawski C, Wollstein A, Takao M, Kennedy (2016) Operative treatment of lateral ankle instability. JBJS Rev 4:1–11

    Article  Google Scholar 

  22. Yeo ED, Lee KT, Sung IH, Lee SG, Lee YK (2016) Comparison of all-inside arthroscopic and open techniques for the modified Broström procedure for ankle instability. Foot Ankle Int 37:1037–1045

    Article  Google Scholar 

Download references

Funding

No funding has been received for this study.

Author information

Authors and Affiliations

  1. Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA

    Alexandra J. Brown, Yoshiharu Shimozono, Eoghan T. Hurley & John G. Kennedy

  2. Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Yoshiharu Shimozono

  3. Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Yoshiharu Shimozono

  4. Royal College of Surgeons in Ireland, Dublin, Ireland

    Eoghan T. Hurley

Authors
  1. Alexandra J. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiharu Shimozono
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eoghan T. Hurley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John G. Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John G. Kennedy.

Ethics declarations

Conflict of interest

The authors report the following potential conflicts of interest or sources of funding: J.G.K. receives support from Ohnell Family Foundation and Mr. and Mrs. Michael J. Levitt.

Ethical approval

This manuscript is a systematic review and meta-analysis and does not contain any studies with human participants of animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brown, A.J., Shimozono, Y., Hurley, E.T. et al. Arthroscopic versus open repair of lateral ankle ligament for chronic lateral ankle instability: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 28, 1611–1618 (2020). https://doi.org/10.1007/s00167-018-5100-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5100-6

Keywords

Search

Navigation