Importance Chronic lateral ankle instability (CAI) is a common entity in current orthopaedic practice. In case a patient is eligible for surgery, several types of procedure can be performed. Complications and recurrence rates may influence treatment choice.
Objective To determine which stabilisation technique provides the lowest complication and recurrence rates in the surgical treatment of CAI.
Evidence review PubMed, Embase, Medline and Cochrane from 1950 up to April 2016 were searched. The inclusion criteria were reporting complications and/or recurrence rates, minimum age of 18 years, isolated CAI unresponsive to conservative treatment and surgical stabilisation. Articles were excluded in case of reviews, case reports, non-English published articles, medial instability, concomitant pathology or joint deformity. The Modified Coleman Methodology Score (0–90 points) was used to assess article methodology. For the analysis, patient demographics, surgical procedure, complications, complication and recurrence rates, and time to recurrence were extracted. From these data the weighted mean, SD and 95% CI were calculated.
Findings The search resulted in 654 articles, of which 27 were eligible and remained for qualitative and quantitative analyses. These articles included a total of 1133 patients with a mean age of 28.1 (SD±4.4) years. The mean Coleman score was 46.9 points (SD±13.1). Complications were reported for 16.5% (n=183) and recurrence was reported for 9.8% (n=44) of patients. The comparison of the OR of complications per technique showed that the tenodesis technique (OR: 1.9; 95% CI: 1.2 to 2.8) had the highest risk of complications. There was no significant difference in complication risk among anatomic repair, anatomic reconstruction and capsular shrinkage. Overall complication rates ranged from 9.1% to 21.0%. Risk at recurrence did not differ among the techniques (OR: 0.7–2.0; 95% CI: 0.4 to 6.3). This study is mainly limited due to inconsistent reporting of complication and recurrence rates.
Conclusions and relevance Tenodesis provides the highest risk of postoperative complications. Among anatomic repair, anatomic reconstruction and capsular shrinkage, there is no difference in complication risk. Conclusions on recurrence of instability are not solid due to under-reporting. To increase current knowledge and reliability of results, more homogenous studies are required with adequate reporting of complications and recurrence.
Level of evidence III
- ankle instability
- surgical treatment
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Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
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