Liu Haoyang, Li Hongxu, Shen Mengran, Zhou Yu, Wang Bailiang, Ma Jinhui
Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
Department of Orthopaedic Surgery, Suqian First People's Hospital, Suqian, Jiangsu, China.
Front Surg. 2025 May 19;12:1572345. doi: 10.3389/fsurg.2025.1572345. eCollection 2025.
Chronic ankle instability (CAI) is a prevalent condition often treated with the Broström procedure, sometimes modified by Gould. This study aims to compare the clinical outcomes of patients undergoing the Broström procedure with and without the Gould modification, focusing on the implications for CAI management.
A comprehensive search was conducted across PubMed, EMBASE, Wiley Library, Science Direct, Europe PMC, and Scopus for studies comparing the Broström procedure with and without the Gould modification. The search spanned from the inception of these databases to October 12, 2024, using specific terms related to ankle instability and ligament repair.
Our meta-analysis revealed that there was no significant difference in AOFAS scores, indicating a weak correlation between AOFAS scores and reinforcement of the Inferior Extensor Retinaculum (IER) [mean difference -1.14 (-2.16, -0.11), = 0.03 I2:0%, = 1.000]. Similarly, the reinforcement of IER showed a low correlation with Karlsson scores [mean difference -0.15 (-2.25, 1.96), = 0.89; I2: 48%, = 0.07]. The results for talar tilt [mean difference -0.11° (-0.37, 0.15), = 0.42; I2:0%, = 0.87] and anterior talar translation [mean difference 0.09 mm (-0.10, 0.29), = 0.34; I2:0%, = 0.91] were similar between the two groups at follow-up. The funnel plots for AOFAS scores, talar tilt, and complications were symmetrical, indicating no publication bias or other biases in the studies.
The findings suggest that for patients with CAI, the Broström procedure with or without the Gould modification yields comparable postoperative functional outcomes. This has significant implications for the surgical management of CAI, potentially simplifying treatment protocols. Level II, systematic review of Level II studies.
慢性踝关节不稳（CAI）是一种常见病症，常采用布罗斯特伦手术治疗，有时会根据古尔德的方法进行改良。本研究旨在比较接受布罗斯特伦手术且有或没有古尔德改良的患者的临床结果，重点关注对CAI治疗的影响。
在PubMed、EMBASE、Wiley Library、Science Direct、欧洲生物医学与健康科学电子图书馆（Europe PMC）和Scopus数据库中进行全面检索，以查找比较有或没有古尔德改良的布罗斯特伦手术的研究。检索时间跨度从这些数据库建立至2024年10月12日，使用与踝关节不稳和韧带修复相关的特定术语。
我们的荟萃分析显示，美国足踝外科协会（AOFAS）评分无显著差异，表明AOFAS评分与伸肌下支持带（IER）加强之间的相关性较弱[平均差 -1.14（-2.16，-0.11），P = 0.03；I²：0%，Z = 1.000]。同样，IER加强与卡尔森评分的相关性较低[平均差 -0.15（-2.25，1.96），P = 0.89；I²：48%，Z = 0.07]。随访时两组在距骨倾斜[平均差 -0.11°（-0.37，0.15），P = 0.42；I²：0%，Z = 0.87]和距骨前移[平均差0.09毫米（-0.10，0.29），P = 0.34；I²：0%，Z = 0.91]方面的结果相似。AOFAS评分、距骨倾斜和并发症的漏斗图是对称的，表明研究中不存在发表偏倚或其他偏倚。
研究结果表明，对于CAI患者，有或没有古尔德改良的布罗斯特伦手术术后功能结果相当。这对CAI的手术治疗具有重要意义，可能会简化治疗方案。二级，对二级研究的系统评价。
