Shan Lei, Zhao Binzhi, Wang Hanzhou, Zhao Yanrui, Diao Shuo, Xu Xiaopei, Gao Yuling, Sun Qingnan, Lu Tianchao, Zhou Junlin, Liu Yang
Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Orthop J Sports Med. 2024 Dec 20;12(12):23259671241270305. doi: 10.1177/23259671241270305. eCollection 2024 Dec.
Approximately 20% of acute ankle sprains progress to chronic lateral ankle instability (CLAI), requiring surgical intervention. When only the anterior talofibular ligament (ATFL) is ruptured, it is controversial whether to perform arthroscopic inferior extensor retinacular (IER) reinforcement.
To assess the postoperative outcomes of IER reinforcement versus nonreinforcement in arthroscopic treatment of CLAI with ATFL-only injury.
Systematic review; Level of evidence, 3.
Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the PubMed, Cochrane Library, Embase, and Web of Science databases were searched for publications on arthroscopic ATFL repair with versus without IER reinforcement. The final search date was July 7, 2023. Through a comprehensive meta-analysis, functional outcomes (American Orthopaedic Foot & Ankle Society Ankle-Hindfoot [AOFAS], Karlsson-Peterson [K-P], and Foot and Ankle Outcome Score [FAOS] scores), radiological outcomes (talar anterior translation and talar tilt), and complication rates (superficial peroneal nerve injury, knot irritation, and total complications) were evaluated. The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes between the patients with versus without IER reinforcement.
A total of 4 studies (n = 271 patients; 157 male, 114 female; 141 patients with IER reinforcement, 130 without IER reinforcement) were included in the final analysis. There were no significant differences between the patients with versus without reinforcement regarding AOFAS score (MD = 0.72 [95% CI, -2.17 to 3.61]; = .63; = 0%), any of the FAOS subscores, talar anterior translation (MD = 0.10 [95% CI, -0.53 to 0.73]; = .76; = 0%), talar tilt (MD = 0.14 [95% CI, -0.86 to 1.13]; = .79; = 0%), or total complications (OR = 2.29 [95% CI, 0.92 to 5.71]; = .07; = 24%). However, the IER reinforcement group showed superior postoperative K-P scores compared with the nonreinforcement group (MD = 6.22 [95% CI, 2.17 to 10.26]; = .003; = 0%).
The results of the meta-analysis suggest that IER reinforcement may not be necessary for achieving satisfactory postoperative outcomes in CLAI with ATFL-only injury. Further research is required to investigate the impact of ligament injury severity, body weight, and concomitant calcaneofibular ligament injuries on the results.
CRD42023447669 (PROSPERO).
约20%的急性踝关节扭伤会发展为慢性外侧踝关节不稳定（CLAI），需要手术干预。当仅前距腓韧带（ATFL）断裂时，对于是否进行关节镜下伸肌下支持带（IER）增强术存在争议。
评估在关节镜治疗仅ATFL损伤的CLAI时，IER增强术与不增强术的术后效果。
系统评价；证据等级，3级。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南，检索PubMed、Cochrane图书馆、Embase和Web of Science数据库中关于关节镜下ATFL修复术加与不加IER增强术的文献。最终检索日期为2023年7月7日。通过全面Meta分析，评估功能结果（美国矫形足踝协会踝-后足[AOFAS]、卡尔松-彼得森[K-P]和足踝结果评分[FAOS]）、放射学结果（距骨前移和距骨倾斜）以及并发症发生率（腓浅神经损伤、结刺激和总并发症）。比较IER增强组与未增强组患者连续结果的平均差（MD）以及分类结果的比值比（OR）；
最终分析纳入4项研究（n = 271例患者；男157例，女114例；141例患者接受IER增强术，130例未接受IER增强术）。在AOFAS评分（MD = 0.72 [95%CI，-2.17至3.61]；P = 0.63；I² = 0%）、任何一项FAOS子评分、距骨前移（MD = 0.10 [95%CI，-0.53至0.73]；P = 0.76；I² = 0%）、距骨倾斜（MD = 0.14 [95%CI，-0.86至1.13]；P = 0.79；I² = 0%）或总并发症方面（OR = 2.29 [95%CI，0.92至5.71]；P = 0.07；I² = 24%），增强组与未增强组患者之间无显著差异。然而，IER增强组术后K-P评分高于未增强组（MD = 6.22 [95%CI，2.17至10.26]；P = 0.003；I² = 0%）。
Meta分析结果表明，对于仅ATFL损伤的CLAI，IER增强术可能并非获得满意术后效果所必需。需要进一步研究以探讨韧带损伤严重程度、体重和跟腓韧带合并损伤对结果的影响。
CRD（42023447669）（PROSPERO）
