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PURPOSE: The purpose of this systematic review and network meta-analysis was to compare the efficacy of different surgical treatments, including open and arthroscopic modified Broström procedures (MB), anatomical reconstructions, and suture tape augmentations (STA), for chronic lateral ankle instability (CLAI). METHODS: We conducted a systematic search for comparative studies that included adult patients with CLAI who underwent open MB, arthroscopic MB, reconstruction with autografts or allografts, and STA. We used a random-effects model to present the NMA results, with mean differences and 95 % confidence intervals (CI) for continuous measures and relative ratios with 95 % CI for dichotomous variables. Surface under the cumulative ranking curve analysis (SUCRA) was used for treatment ranking. RESULTS: The results, based on surface under the cumulative ranking curve analysis, showed that arthroscopic MB likely improves functional outcomes the most as measured by change in American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. Anatomical graft reconstructions with allografts or autografts demonstrated greater reduction in anterior talar translation (ATT) and talar tilt angle (TTA). Arthroscopic MB and STA were associated with fewer complications. CONCLUSIONS: Arthroscopic MB may be associated with better functional outcomes, while anatomical reconstructions appear to provide greater improvements in stability for CLAI. Additionally, arthroscopic techniques seem to have lower complication risks compared to open procedures. These potential differences in outcomes and risks between techniques could help guide surgical decision-making.

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Injury to the lateral ligament is the most common cause of chronic lateral ankle instability. Lateral ankle instability is usually managed through conservative management, but surgery is indicated if this fails to relieve the symptoms. Surgical repair of the lateral ligament involves many surgical techniques including the arthroscopic repair technique and the modified Brostrom-Gould technique. Due to the minimal research on the complication rates of both techniques, this systematic review aims to establish the complication rates. To obtain articles, a detailed systematic search of MEDLINE, PubMed, Embase, Web of Science, and Cochrane Library was performed. The articles found using the keywords "arthroscopic," "Brostrom," and "Brostrom-Gould" were reviewed by two independent authors. The authors then selected the articles according to our predetermined eligibility criteria. The articles that met our inclusion were then chosen for data extraction. Specific details obtained from the study included the author's details, the setting of the study, and the complications of the study. The online search yielded 975 articles, but only 44 met our inclusion criteria and were included in the review. The total sample size for the review was 2041 patients, the modified Brostrom technique was performed on 760 patients while on the remaining 1281 patients, arthroscopic repair was performed. On the characteristics of the sample, the age of the samples ranged from eight years to 83 years, while the mean BMI ranged from 21.0 kg/m² to 25.3 kg/m². The various complication rates included superficial peroneal nerve injury (2.3% in arthroscopic Brostrom and 0.65% in the Brostrom-Gould), wound infections (1.3% in arthroscopic Brostrom and 1.8% in the Brostrom-Gould), persistent pain (1.5% in the arthroscopic Brostrom and 1.1% in the Brostrom-Gould), and lastly recurrent instability (0.31% in arthroscopic Brostrom and 3.0% in the Brostrom-Gould). Overall, the complication rates of the arthroscopic repair were 11.00%, while those of the modified Brostrom-Gould were 10.65%. The study demonstrated that although the arthroscopic technique had higher complication rates than the modified Brostrom technique, the difference was insignificant. Therefore, we concluded that surgeons performing the arthroscopic Brostrom technique should have good arthroscopic skills to minimize complications.

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Introduction  Modified Brostrom-Gould surgery (MBG) aims to repair the lateral ligaments of the ankle in patients with ligamentous laxity and chronic instability. Brostrom-Gould surgery-the Brostrom technique associated with Gould augmentation-is currently the gold standard surgical option for chronic ankle instability worldwide. Chronic lateral ankle instability caused by lateral ankle sprains is one of the most common sports-related injuries, and Brostrom-Gould surgery is commonly recommended as the operative treatment. While arthroscopic surgery is becoming the more heavily favored approach of choice, open Brostrom-Gould surgery is still pertinent for patients for whom arthroscopic repair is unsuitable. Aim This paper discusses a modified mini-open approach of the open Brostrom-Gould surgery with a smaller incision (1.5 cm) and aims to study the outcomes of this modified approach on patients' post-operative pain, stability, and functional outcome. Methods Forty-two patients were followed up for a mean of 2.6 years after undergoing modified mini-open Brostrom-Gould surgery. The Visual Analog Scale (VAS), the Foot and Ankle Outcome Score (FAOS), and Karlsson scores were used to monitor their post-operative recovery. The Wilcoxon signed-rank test and the SPSS Statistics (v.28.0.1) software were used for data management and analytics. Results The results showed a mean Karlsson score of 83.4, a mean FAOS score of 69.7, and a mean VAS score of 1.33. These results are comparable to studies conducted on conventional open Brostrom-Gould repair. Conclusion The modified mini-open Brostrom Gould provides a favorable functional outcome with a reduction in pain and suggests no decrease in efficacy with the modified approach. This is coupled with the added advantages of a smaller wound, better wound healing outcomes, and availability to patients not suited to arthroscopic repair.

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Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. Failure after strict rehabilitation may be an indication for surgery. Several operative options are available, including anatomic repair, anatomic reconstruction, and tenodesis procedures. Anatomic repair can be performed when the quality of the damaged ligaments permits. Anatomic reconstruction with an autograft or allograft should be considered when the torn ligaments are not adequate. Ankle arthroscopy is a useful adjunct to ligamentous procedures, performed at the time of repair to identify and treat intra-articular conditions that may be associated with chronic ankle instability. Tenodesis techniques are not recommended because of their suboptimal long-term results related to the modification of ankle and hindfoot biomechanics.Level of Evidence: Level V, expert opinion.

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OBJECTIVE: To compare the effectiveness of all-arthroscopic technique and modified open Broström technique in repair of anterior talofibular ligament (ATFL) for lateral instability of the ankle (LIA). METHODS: A retrospective analysis was made on 65 patients who underwent ATFL repair with anchors for LIA between January 2014 and January 2017. The ATFL was repaired by all-arthroscopic technique in 35 patients (arthroscopic group) and modified open Broström technique in 30 patients (open group). There was no significant difference in age, gender, the side of injured ankle, the time from injury to operation, and preoperative anterior displacement of talus, tilt angle of talus, the Karlsson Ankle Functional (KAF) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Japanese Society for Surgery of the foot ankle-hindfoot (JSSF) scale score between the two groups (P>0.05). The operation time, the intraoperative bleeding volume, and the length of time for surgery recovery were recorded. The anterior displacement of talus, the tilt angle of talus, KAF score, AOFAS score, and JSSF scale score were evaluated at 2 weeks, 3 months, and the last follow-up. RESULTS: All patients were followed up 24-30 months, with an average of 26 months. The operation time, intraoperative bleeding volume, and the length of time for surgery recovery of arthroscopic group were superior to open group (P<0.05). There were 2 cases of temporary ankle and dorsum numbness and 1 case of thread reaction in arthroscopic group; and there were 2 cases of temporary ankle and dorsum numbness and 2 cases of thread reaction in open group. The AOFAS score, KAF score, and JSSF scale score in arthroscopic group were significantly higher than those in open group (P<0.05) at 2 weeks after operation; there was no significant difference between the two groups at 3 months and the last follow-up (P>0.05). There was no significant difference in the anterior displacement of talus and the tilt angle of talus between the two groups at 2 weeks, 3 months, and last follow-up (P>0.05). CONCLUSION: Compared with the modified open Broström technique, the all-arthroscopic technique, as a minimally invasive technique, can achieve the same effectiveness, and has the advantages of shorter operation time, less intraoperative bleeding, and less pain in the early stage.

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PURPOSE: The all-inside arthroscopic modified Broström operation has been developed for lateral ankle instability. We compared the biomechanical parameters of the all-inside arthroscopic procedure to the open modified Broström operation. METHODS: Eleven matched pairs of human cadaver specimens [average age 71.5 (range 58-98) years] were subject to the arthroscopic modified Broström operation using a suture anchor and the open modified Broström operation. The ligaments were loaded cyclically 20 times and then tested to failure. Torque to failure, degrees to failure, and stiffness were measured. A matched-pair analysis was performed. RESULTS: There was no significant difference in torque to failure between the open and arthroscopic modified Broström operation (19.9 ± 8.9 vs. 23.3 ± 12.1 Nm, n.s). The degrees to failure did not differ significantly between the open and arthroscopic modified Broström operations (46.8 ± 9.9° vs. 46.7 ± 7.6°, n.s). The working construct stiffness (or stiffness to failure) was no significant difference in the two groups (0.438 ± 0.21 vs. 0.487 ± 0.268 Nm/deg for the open and arthroscopic modified Broström operations, respectively, n.s). CONCLUSION: The all-inside arthroscopic modified Broström operation and the open modified Broström operation resulted in no significantly different torque to failure, degrees to failure, and working construct stiffness with no significant differences (n.s, n.s, and n.s, respectively). Our results indicate that the arthroscopic modified Broström operation is a reasonable alternative procedure for chronic ankle instability.

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