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Minimally invasive surgical treatment for chronic ankle instability: a systematic review

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to determine the evidence-based support for the treatment for chronic ankle instability (CAI) using minimally invasive surgery (MIS) techniques.

Methods

A systematic comprehensive review of the literature was performed on 4 September 2015 using PubMed, EMBASE, Cochrane databases and Web of Science along with the two search concepts: lateral ligament of the ankle (patients) and minimally invasive surgical procedure (intervention). Articles of clinical study on MIS for CAI were included in this review and classified into four MIS categories (arthroscopic repair, non-arthroscopic minimally invasive repair, arthroscopic reconstruction and non-arthroscopic minimally invasive reconstruction) based on the adopted surgical procedure. Included articles were reviewed and assigned a classification according to the research method quality of evidence (Level I–V evidence). Analysis of these studies was then conducted to provide a grade of recommendation for each MIS category.

Results

The systematic literature review generated 430 articles, and 33 articles met our inclusion criteria. The highest recommendation was Grade C (poor-quality evidence) to support the use of the arthroscopic repair, arthroscopic reconstruction and non-arthroscopic minimally invasive reconstruction. Insufficient evidence was currently available to make any recommendation (Grade I) for non-arthroscopic minimally invasive repair category.

Conclusions

Despite recent increases in publications on MIS for the treatment for CAI, there was currently poor quality of evidence that was insufficient to allow a high grade of recommendation to support the use of the MIS. This paper should stimulate those surgeons performing higher quality studies in the form of prospective and preferably randomized comparative studies that will be necessary to allow better recommendations for the treatment for CAI with MIS. The present study showed thorough evidence-based recommendation for the clinical use of the MIS based on the comprehensive review of the literature.

Level of evidence

Systematic review, Level IV.

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Abbreviations

ATFL:

Anterior talofibular ligament

CFL:

Calcaneofibular ligament

PTFL:

Posterior talofibular ligament

CAI:

Chronic ankle instability

MIS:

Minimally invasive surgeries

AOFAS score:

American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score

IER:

Inferior extensor retinaculum

BMI:

Body mass index

VAS:

Visual analog scale for pain

ADT:

Anterior drawer test

TTA:

Talar tilting angle

NA:

Not applicable

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Acknowledgments

ESSKA AFAS Ankle Instability Group, The European Society of Sports Traumatolgy, Knee Surgery and Arthroscopy Ankle and Foot Associates Ankle Instability Group, comprises Jorge Batista, Thomas Bauer, James Calder, Woo Jin Choi, Ali Ghorbani, Mark Glazebrook, Stéphane Guillo, Siu Wah Kong, Jon Karlsson, Jin Woo Lee, Peter G. Mangone, Frederick Michels, Andy Molloy, Caio Nery, Satoru Ozeki, Christopher Pearce, Anthony Perera, Hélder Pereira, Bas Pijnenburg, Fernando Raduan, James W. Stone, Masato Takao, Yves Tourné.

Authors’ contributions

KM and BB have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data, and have been involved in drafting the manuscript or revising it critically for important intellectual content. MT, JS and SG agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MG has given final approval of the version to be published. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Queen Elizabeth II Health Sciences Center Halifax Infirmary, Dalhousie University, 1796 Summer Street Halifax, Nova Scotia, B3H3A7, Canada

    Kentaro Matsui & Bernard Burgesson

  2. Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan

    Kentaro Matsui

  3. Department of Orthopaedic Surgery, Teikyo Institute of Sports Science and Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan

    Masato Takao

  4. Department of Sport and Medical Science, Teikyo Institute of Sports Science and Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan

    Masato Takao

  5. Medical College of Wisconsin, Milwaukee, WI, USA

    James Stone

  6. Sport’s Medical Clinic of Bordeaux, Bordeaux-Mérignac, France

    Stéphane Guillo

  7. Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), Dalhousie University, 1796 Summer Street Halifax, Nova Scotia, B3H3A7, Canada

    Mark Glazebrook

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  1. Kentaro Matsui
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ESSKA AFAS Ankle Instability Group

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Correspondence to Kentaro Matsui.

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Matsui, K., Burgesson, B., Takao, M. et al. Minimally invasive surgical treatment for chronic ankle instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 24, 1040–1048 (2016). https://doi.org/10.1007/s00167-016-4041-1

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