Medical Student, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Medical Officer, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
J Foot Ankle Surg. 2021 May-Jun;60(3):577-584. doi: 10.1053/j.jfas.2020.10.001. Epub 2020 Oct 7.
Arthroscopic repair of the anterior talofibular ligament is becoming increasingly popular as a surgical option for lateral ankle instability. However, studies directly comparing outcomes of open and arthroscopic anterior talofibular ligament repair continue to present conflicting conclusions. This review aims to compare the clinical outcomes of arthroscopic and open Broström procedure. A systematic literature review was performed using MEDLINE, Cochrane Library, and EMBASE from January 2010 to March 2020 to identify all clinical studies (level of evidence I-III) comparing outcomes of arthroscopic versus open Broström procedure for chronic lateral ankle instability. Six studies were included in this review. The arthroscopic technique, compared to the open technique, resulted in higher American Orthopaedic Foot and Ankle Society scores (weighted mean difference [WMD] = 1.20, 95% confidence interval [CI]: 0.05-2.34, p= .04), higher Karlsson scores (WMD = 1.86, 95% CI: 0.46-3.25, p= .009) and lower Visual Analog Scale pain scores (WMD = -0.31, 95% CI: -0.51 to -0.10, p= .003). There were no differences between the groups in terms of postoperative anterior drawer test (WMD = -0.10, 95% CI: -0.60 to 0.39, p= .68), talar tilt (WMD = 0.31, 95% CI: -0.10 to 0.72, p= .14) or overall complication rates (odds ratio [OR] = 0.78, 95% CI: 0.37-1.64, p= .51). The odds of wound-related complications in arthroscopic Broström procedures was significantly lower than that of open Broström procedures (OR = 0.25, 95% CI: 0.07-0.95, p= .04). Current evidence shows that arthroscopic repairs offer comparable clinical outcomes with a lower wound complication rate, compared to traditional open repairs.
关节镜下修复距腓前韧带越来越多地成为治疗外侧踝关节不稳定的一种手术选择。然而，直接比较开放和关节镜下距腓前韧带修复术结果的研究仍存在相互矛盾的结论。本综述旨在比较关节镜下和开放的 Broström 手术的临床结果。我们使用 MEDLINE、Cochrane 图书馆和 EMBASE 进行了系统的文献回顾，检索了 2010 年 1 月至 2020 年 3 月期间所有比较慢性外侧踝关节不稳定的关节镜下与开放的 Broström 手术结果的临床研究（证据水平 I-III）。本综述纳入了 6 项研究。与开放技术相比，关节镜技术导致更高的美国矫形足踝协会评分（加权均数差 [WMD] = 1.20，95%置信区间 [CI]：0.05-2.34，p =.04）、更高的 Karlsson 评分（WMD = 1.86，95%CI：0.46-3.25，p =.009）和更低的视觉模拟量表疼痛评分（WMD = -0.31，95%CI：-0.51 至 -0.10，p =.003）。两组在术后前抽屉试验（WMD = -0.10，95%CI：-0.60 至 0.39，p =.68）、距骨倾斜（WMD = 0.31，95%CI：-0.10 至 0.72，p =.14）或总体并发症发生率（比值比 [OR] = 0.78，95%CI：0.37-1.64，p =.51）方面无差异。关节镜下 Broström 手术的切口相关并发症发生率明显低于开放 Broström 手术（OR = 0.25，95%CI：0.07-0.95，p =.04）。目前的证据表明，与传统的开放修复相比，关节镜下修复具有相似的临床结果，但切口并发症发生率较低。
