Song Yu-Jie, Hua Ying-Hui
Surgeon, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Professor, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
J Foot Ankle Surg. 2019 Mar;58(2):312-319. doi: 10.1053/j.jfas.2018.08.026.
Although the open modified Broström technique remains widely accepted as the gold standard for operative treatment of ankle instability, use of the arthroscopic repair technique has been rapidly increasing. Our aim is to conduct a comparative systematic review and meta-analysis of the data to determine whether there is a significant difference in clinical outcomes between arthroscopic and open repair for lateral ankle instability. A systematic literature review was performed using PubMed, Web of Science, the Cochrane Library, and EMBASE from 1980 to March 2018 to identify all English-language studies (level of evidence 1 to 3) comparing functional outcomes of arthroscopic versus open repair of lateral ankle instability. Four studies (1 level 1, 3 level 3) involving 207 patients met inclusion criteria. Of those, 97 participants were treated with arthroscopic repair, and 110 were treated with open repair. All of the subjective outcomes were improved for both groups across the 4 studies, without a significant difference in improvement between groups, except in 1 study, in which time to return to daily activity was significantly shorter in arthroscopic group (p < .05). Overall, this review demonstrated no statistically significant difference in outcome measures between arthroscopic versus open repair, both of which reported favorable and satisfactory outcomes, and produced equivalent clinical results. Additional randomized controlled studies of larger numbers of patients with longer follow-up times, however, are required to confirm whether arthroscopic repair leads to earlier recovery.
尽管开放式改良布罗斯特伦技术仍然被广泛接受为踝关节不稳手术治疗的金标准，但关节镜修复技术的应用一直在迅速增加。我们的目的是对数据进行比较性系统评价和荟萃分析，以确定踝关节外侧不稳的关节镜修复与开放式修复在临床结果上是否存在显著差异。利用PubMed、科学网、考克兰图书馆和EMBASE对1980年至2018年3月的文献进行系统回顾，以识别所有比较踝关节外侧不稳关节镜修复与开放式修复功能结果的英文研究（证据级别为1至3级）。四项研究（1项1级、3项3级）涉及207例患者，符合纳入标准。其中，97名参与者接受了关节镜修复治疗，110名接受了开放式修复治疗。在这四项研究中，两组的所有主观结果均有所改善，除一项研究外，两组之间的改善无显著差异，在该研究中，关节镜组恢复日常活动的时间明显更短（p<0.05）。总体而言，本评价表明关节镜修复与开放式修复在结果指标上无统计学显著差异，两者均报告了良好且令人满意的结果，并产生了等效的临床效果。然而，需要更多患者、更长随访时间的额外随机对照研究来证实关节镜修复是否能带来更早的恢复。
