Attia Ahmed Khalil, Taha Tarek, Mahmoud Karim, Hunt Kenneth J, Labib Sameh A, d'Hooghe Pieter
Private practice, Cairo, Egypt.
Cleveland Clinic, Cleveland, Ohio, USA.
Orthop J Sports Med. 2021 Jul 21;9(7):23259671211015207. doi: 10.1177/23259671211015207. eCollection 2021 Jul.
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.
To review the most up-to-date evidence comparing the outcomes of open and arthroscopic Broström procedures for chronic lateral ankle instability.
Systematic review; Level of evidence, 3.
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.
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; = 90%; = .03), 1-year AOFAS scores (80.05 vs 88.6; MD, -11.96; 95% CI, -21.26 to -2.76; = 82%; = .01), 6-month VAS scores (1.7 vs 1.4; MD, -0.38; 95% CI, -0.54 to -0.21; = 78%; < .001), and 1-year VAS scores (2.05 vs 1.45; MD, 0.31; 95% CI, 0.09-0.54; = 0%; < .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; = 99%; < .001). There were no statistically significant differences in the remaining outcomes evaluated.
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.
近20%的急性踝关节扭伤会发展为慢性外侧踝关节不稳定，需要手术干预。近年来，关节镜下布罗斯特伦技术作为开放手术的替代方法，越来越受到关注。
回顾比较开放手术和关节镜下布罗斯特伦手术治疗慢性外侧踝关节不稳定疗效的最新证据。
系统评价；证据等级，3级。
本评价按照PRISMA（系统评价和Meta分析的首选报告项目）指南进行。检索截至2020年5月的英文相关比较研究。主要结局指标为：（1）功能评分（卡尔松踝关节功能评分和美国矫形足踝协会[AOFAS]评分）；（2）疼痛的10分视觉模拟量表（VAS）评分。次要结局指标为：（1）术后前抽屉试验和距骨倾斜度的差异；（2）手术时间和并发症发生率；（3）恢复运动和负重的时间。
8项研究中的408例患者符合纳入标准。其中，193例（47.3%）患者接受了开放手术，215例（52.7%）患者接受了关节镜手术。开放修复组和关节镜修复组在6个月时的平均AOFAS评分（分别为82.4和92.25；平均差值[MD]，11.36；95%置信区间，0.14 - 2.56；P = 90%；P = 0.03）、1年时的AOFAS评分（80.05和88.6；MD， - 11.96；95%置信区间， - 21.26至 - 2.76；P = 82%；P = 0.01）、6个月时的VAS评分（1.7和1.4；MD， - 0.38；95%置信区间， - 0.54至 - 0.21；P = 78%；P < 0.001）以及1年时的VAS评分（2.05和1.45；MD，0.31；95%置信区间，0.09 - 0.54；P = 0%；P < 0.001）方面存在显著差异。开放修复组和关节镜修复组的平均负重时间分别为14.25周和9.0周（MD，1.89；95%置信区间，1.24 - 2.54；P = 99%；P < 0.001）。在评估的其余结局指标方面，未发现统计学上的显著差异。
虽然关节镜下布罗斯特伦技术在技术上要求更高，但在术后AOFAS评分、VAS疼痛评分和恢复负重时间方面优于开放的布罗斯特伦 - 古尔德手术。手术时间、并发症发生率、距骨倾斜度和前抽屉试验结果良好，且在统计学上具有可比性。在推荐关节镜下布罗斯特伦技术作为新的金标准之前，需要进行长期临床试验。
