Vopat Matthew L, Lee Brennan, Mok Anthony C, Hassan Maaz, Morris Brandon, Tarakemeh Armin, Zackula Rosey, Mullen Scott, Schroeppel Paul, Vopat Bryan G
Department of Orthopaedics-University of Kansas School of Medicine-Wichita, Wichita.
University of Kansas School of Medicine-Wichita, Wichita.
Arthrosc Sports Med Rehabil. 2022 Mar 1;4(2):e747-e762. doi: 10.1016/j.asmr.2021.09.023. eCollection 2022 Apr.
To analyze the literature to compare outcomes and complications following primary lateral ankle ligament repair compared with lateral ankle ligament reconstruction and the suture tape augmentation in patients with lateral ankle instability.
Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, a systematic literature review using the PubMed/Ovid Medline database was performed (October 11, 1947, to October 1, 2019). Clinical trials that included all the following criteria were considered eligible; published in the English language; patients undergoing primary lateral ankle repair or reconstruction with/without autograft or allograft (anterior talofibular ligament, anterior talofibular ligament + calcaneofibular ligament) or suture tape augmentation; a follow-up at least 1 year; reported least 1 of the measured outcomes (The American Orthopaedic Foot Ankle Score, Karlsson Score, return to sport [RTS], complications, skin wound complications, reoperation). Surgical techniques were evaluated, and studies were subdivided by the following categories: primary repair (PR), reconstruction with graft (GR), and suture tape augmentation (STA). Complications, radiographic outcomes, functional outcome scores, and RTS were analyzed.
A total of 41 of 1,991 studies met the criteria for final analysis. This included 1,920 patients who underwent surgical intervention for chronic lateral instability with at least a 1-year follow-up. There were 350 patients who had GR, 1,486 who underwent the PR, and 84 who had STA. GR group appeared to have the lowest rate of complications: GR 3.1% (11 of 350), PR 4.2% (63 of 1486), and STA 10.7% (9 of 84). Postoperative American Orthopaedic Foot Ankle Score ranged from 89.0 to 95.1 for GR and 90.0 to 98.8 for PR. Postoperative Karlsson scores ranged from 80.9 to 94.4 for GR and from 89.2 to 94.1 for PR. Anterior drawer postoperative scores ranged from 1.4 to 30.3 mm for GR, 2.7 to 8.6 mm for PR, and 4.1 to 4.2 mm for STA. Postoperative talar tilt ranged from 2.4 to 7.3° for GR, 1.9 to 6.0° for PR, and 3.6 to 4.5° for STA. RTS ranged from 9.5 to 20.4 weeks for the PR group; one study reported a RTS of 10.6 weeks for STA.
Excellent outcomes were noted across all intervention groups. Current literature may suggest there is no difference in functional outcomes between patients treated with PR versus GR. However, there may be a potential improvement in functional outcomes with PR versus STA.
Level IV, systematic review of Level I to Level IV studies.
分析文献，比较初次外侧踝关节韧带修复、外侧踝关节韧带重建及缝线带增强术治疗外侧踝关节不稳患者的疗效和并发症。
按照系统评价和Meta分析的首选报告项目（PRISMA）标准，使用PubMed/Ovid Medline数据库进行系统文献回顾（1947年10月11日至2019年10月1日）。纳入所有符合以下标准的临床试验：以英文发表；接受初次外侧踝关节修复或重建（使用/不使用自体移植物或同种异体移植物，如距腓前韧带、距腓前韧带+跟腓韧带）或缝线带增强术的患者；随访至少1年；报告至少1项测量结果（美国矫形足踝评分、卡尔松评分、恢复运动[RTS]、并发症、皮肤伤口并发症、再次手术）。评估手术技术，并按以下类别对研究进行细分：初次修复（PR）、带移植物重建（GR）和缝线带增强术（STA）。分析并发症、影像学结果、功能结局评分和RTS。
1991项研究中有41项符合最终分析标准。这包括1920例因慢性外侧不稳接受手术干预且至少随访1年的患者。其中350例行GR，1486例行PR，84例行STA。GR组并发症发生率似乎最低：GR组为3.1%（350例中的11例），PR组为4.2%（1486例中的63例），STA组为10.7%（84例中的9例）。GR组术后美国矫形足踝评分为89.0至95.1分，PR组为90.0至98.8分。GR组术后卡尔松评分为80.9至94.4分，PR组为89.2至94.1分。GR组术后前抽屉试验评分为1.4至30.3mm，PR组为2.7至8.6mm，STA组为4.1至4.2mm。GR组术后距骨倾斜度为2.4至7.3°，PR组为1.9至6.0°，STA组为3.6至4.5°。PR组的RTS为9.5至20.4周；一项研究报告STA组的RTS为10.6周。
所有干预组均取得了良好疗效。当前文献可能表明，PR与GR治疗的患者在功能结局上无差异。然而，PR与STA相比，功能结局可能有潜在改善。
IV级，I级至IV级研究的系统评价。
