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

• Authors: Ahmed Khalil Attia, Aspetar Orthopaedic & Sports Medicine Hospital; Tarek Taha, Aspetar Orthopaedic & Sports Medicine Hospital; Karim Mahmoud, Aspetar Orthopaedic & Sports Medicine Hospital; Kenneth J Hunt, Aspetar Orthopaedic & Sports Medicine Hospital; Sameh Labib, Emory University; Pieter D'Hooghe, Aspetar Orthopaedic & Sports Medicine Hospital
• Journal Title: ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE
• Volume: Volume 9, Number 7
• Publisher: SAGE PUBLICATIONS INC | 2021-07-01, Pages 23259671211015207-23259671211015207
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1177/23259671211015207
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Orthopedics; Sport Sciences; lateral ankle instability; open; arthroscopic; Brostrom-Gould; repair; ANTERIOR TALOFIBULAR LIGAMENT; GOULD PROCEDURE; OPEN REPAIR; HINDFOOT; COMPLEX

Abstract

Background: Nearly 20% of acute ankle sprains progress to chronic lateral ankle instability that requires surgical intervention. In recent years, there has been a growing interest in arthroscopic Broström techniques as an alternative to open surgery. Purpose: To review the most up-to-date evidence comparing the outcomes of open and arthroscopic Broström procedures for chronic lateral ankle instability. Study Design: Systematic review; Level of evidence, 3. Methods: This review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant comparative studies in English up to May 2020 were identified. The primary outcomes were (1) functional scores (Karlsson Ankle Function Score and American Orthopaedic Foot & Ankle Society [AOFAS] score) and (2) the 10-point visual analog scale (VAS) score for pain. The secondary outcomes were differences in (1) postoperative anterior drawer and talar tilt, (2) surgical time and complication rate, and (3) time to return to sports and weightbearing. Results: A total of 408 patients in 8 studies met the inclusion criteria. Of these, 193 (47.3%) patients underwent open surgery, while 215 (52.7%) patients underwent arthroscopic surgery. There were significant differences between the open and arthroscopic repair groups in mean 6-month AOFAS scores (82.4 vs 92.25, respectively; mean difference [MD], 11.36; 95% CI, 0.14-2.56; I2 = 90%; P =.03), 1-year AOFAS scores (80.05 vs 88.6; MD, –11.96; 95% CI, –21.26 to –2.76; I2 = 82%; P =.01), 6-month VAS scores (1.7 vs 1.4; MD, –0.38; 95% CI, –0.54 to –0.21; I2 = 78%; P <.001), and 1-year VAS scores (2.05 vs 1.45; MD, 0.31; 95% CI, 0.09-0.54; I2 = 0%; P <.001). The mean time to weightbearing was 14.25 and 9.0 weeks in the open and arthroscopic repair groups, respectively (MD, 1.89; 95% CI, 1.24-2.54; I2 = 99%; P <.001). There were no statistically significant differences in the remaining outcomes evaluated. Conclusion: While technically more demanding, arthroscopic Broström was superior to open Broström-Gould surgery in postoperative AOFAS scores, VAS pain scores, and time to return to weightbearing. The operative time, complication rate, talar tilt, and anterior drawer tests were excellent and statistically comparable. Long-term clinical trials are required before recommending arthroscopic Broström as the new gold standard.