Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy.
Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3534-3542. doi: 10.1007/s00167-021-06721-6. Epub 2021 Aug 29.
Multiple Level I meta-analyses were conducted comparing traditional static vs. more recently introduced dynamic strategies of fixation for injuries of the distal tibiofibular syndesmosis (TFS). The aim of this review was to assess their robustness and methodological quality, providing support in the choice of a treatment strategy in case of TFS injury using the highest level of evidence.
In this systematic review, conducted in accordance with the PRISMA guidelines, meta-analyses/systematic reviews comparing static and dynamic fixation methods after acute TFS injury were identified. The robustness of studies was evaluated using the fragility index (FI) for meta-analysis and the fragility quotient (FQ). The risk of bias was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Finally, the Jadad was applied to select the study which provided the highest quality of evidence to develop recommendations for the fixation strategy of these lesions.
Out of 1.302 records, four Level I meta-analyses were included in this study. Analyzing the statistically significant dichotomous outcomes, the median FI was 3.5 (IQR, 2 to 5.5; range, 1 to 9), while the median FQ was 1.9% (IQR, 1 to 3.5; range 0.35 to 4.4). In total, 37% had an FI of 2 or less and 75% of outcomes had a FI of 4 or less. According to the AMSTAR score and Jadad algorithm, the largest meta-analysis was selected as the highest evidence provided so far.
The meta-analyses with statistically significant dichotomous outcomes comparing dynamic and static fixation for treating injuries of the distal tibiofibular syndesmosis are fragile, with a change in less than four patients or less than 2% of the study population sufficient to reverse a significant outcome to nonsignificant.
Level I.
对比较下胫腓联合（TFS）损伤传统静态与最近引入的动态固定策略的多项 I 级荟萃分析进行了研究。本综述的目的是评估其稳健性和方法学质量，为 TFS 损伤治疗策略的选择提供支持，使用最高级别的证据。
根据 PRISMA 指南，对比较急性 TFS 损伤后静态和动态固定方法的荟萃分析/系统评价进行了系统回顾。使用荟萃分析的脆弱指数（FI）和脆弱分数（FQ）评估研究的稳健性。使用多系统评价评估工具（AMSTAR）评估偏倚风险。最后，应用 Jadad 量表选择提供最高质量证据的研究，为这些病变的固定策略制定建议。
在 1302 条记录中，有 4 项 I 级荟萃分析纳入了本研究。分析具有统计学意义的二分类结果，中位数 FI 为 3.5（IQR，2 至 5.5；范围，1 至 9），中位数 FQ 为 1.9%（IQR，1 至 3.5；范围 0.35 至 4.4）。总体而言，37%的 FI 为 2 或更低，75%的结果 FI 为 4 或更低。根据 AMSTAR 评分和 Jadad 算法，选择最大的荟萃分析作为迄今为止提供的最高证据。
比较动态和静态固定治疗下胫腓联合损伤的具有统计学意义的二分类结果的荟萃分析是脆弱的，研究人群中少于 4 名患者或少于 2%的变化足以将显著结果逆转为不显著。
I 级。
