Other operations Versus MBG Procedure of Chronic Lateral Ankle Instability: a  systematic review and  meta-analysis

doi:10.21203/rs.3.rs-1820151/v1

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Research Article

Other operations Versus MBG Procedure of Chronic Lateral Ankle Instability: a systematic review and meta-analysis

https://doi.org/10.21203/rs.3.rs-1820151/v1

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Background

This study performed a randomized data meta-analysis to assess The Modified Brostrom-Gould (MBG) for proven chronic lateral ankle instability (CLAI).

Methods

All randomized clinical trials comparing Other operations and published MBG were found by searching the Cochrane Library, EMBASE, and PubMed databases. The Review Manager 5.4 software was used to compare the two groups regarding postoperative functional score, ankle stability, and complications. Risk Ratio (RR) and Mean Differences(MD) were used in meta-analyses.

Results

8 experiments are suitable for it, 426 patients were enrolled, and 222 patients underwent Other operations surgery. Among the six outcome indicators, in terms of FAOS scores, the Other operations group has an advantage, 8.34 points higher than MBG; others show no significant differences.

Conclusions

Based on this meta-analysis, the author believes that Other operations have a clinical advantage compared with the Other operations group.

chronic lateral ankle instability1

MBG2

CLAI3

meta-analysis4

Ankle sprains are one of the most prevalent sports injuries, accounting for 15–20% of all injuries(1). While most patients can return to their everyday lives after nonsurgical therapy, some persons suffer CLAI. Patients with sprained ankles often undergo extensive rehabilitation training before being diagnosed. However, more than half of the patients will eventually develop CLAI, leading to talar cartilage injury and early ankle osteoarthritis(2).

The repair of ligaments in postoperative patients depends on the tissues that have been injured; Such conditions require surgical treatment to improve clinical symptoms, improve the ability of daily living, and improve prognosis. MBG is a surgical method for treating CLAI and has long been the first-line choice. However, in recent years, for the treatment of this type of patient, some new surgical methods have emerged, such as LARS, Suture-tape augmentation, Arthroscopic suture-tape internal bracing, the Chrisman-Snook procedure, etc.(3–7). Many scholars have compared these surgical methods with MBG and conducted RCTs for many years. The trial period included in the previous meta-analysis was relatively long. There is still a lack of evidence to support whether MBG can be the first choice for the treatment of CLAI. New randomized controlled trial evidence has emerged recently, so a new meta-analysis is needed. Analyze Other operations in-depth to give evidence-based support for medical decisions.

This study aims to show that Other operations are more effective than MBG in treating CLAI. To our knowledge, this is the first Meta-analysis that incorporates the most recent randomized controlled trial that assesses MBG and many procedures simultaneously.

2.1 Study selection and search strategy

This meta-analysis was implemented by the PRISMA guidelines (the preferred reporting item for systematic reviews and meta-analysis)(8). the ID is CRD42021248704. As of March 1, 2021, we searched various electronic databases, including the Cochrane Library, PubMed, and Embase. Each database was independently searched by two reviewers (Qifan. Y and Jing. L) using the following research methodology: ((((((Ankle[MESH]) OR (Ankle[Title/Abstract])) OR (Lateral Ligament, Ankle[MESH])) OR (Lateral Ligament, Ankle[Title/Abstract])) OR (ankle*[Title/Abstract] AND (injur*[Title/Abstract] OR joint*[Title/Abstract] OR ligament*[Title/Abstract] OR sprain*[Title/Abstract] OR strain*[Title/Abstract] OR inversion*[Title/Abstract] OR rupture*[Title/Abstract] OR tear*[Title/Abstract] OR torn)[Title/Abstract])) AND ((Ligaments, Articular[MESH]) OR (Ligaments, Articular[Title/Abstract]))) AND (((((instability[Title/Abstract] OR unstable[Title/Abstract] OR lax*[Title/Abstract] OR recurrent[Title/Abstract] OR chronic*[Title/Abstract]) OR (Joint Instability[MESH])) OR (Joint Instability[Title/Abstract])) OR (Chronic Disease[MESH])) OR (Chronic Disease[Title/Abstract])) AND (randomized controlled trial[Filter]). The senior author will resolve any disagreements (Lei. T). We looked at the title and abstract of each article we found and then read the complete text of the studies that fulfilled the criteria. Also, I looked through the reference list of the included literature to see whether there was any research that met the criteria. There are no limitations on the location of study, the type of research, or the status of publications.

2.2 Eligibility criteria

All prospective randomized controlled trials evaluating the clinical outcomes of Other operations vs. MBG in the treatment of CLAI are included. (1) Randomized, double-blind, placebo-controlled trials; (2) Studies with at least one of the following clinical outcomes: Ankle Outcome Score (FAOS), Foot and Ankle Ability Measurement Complications (FAAM), Ankle Joint Stability, Complications, Karlsson and Peterson Score, and Tegner Score; (3) Studies with at least one of the following clinical outcomes: Ankle Outcome Score (FAOS), Foot and Ankle Ability Measurement Complications (FAAM), Ankle Joint Stability, Complications, Karlsson-Peterson Score (4) Research in full text is available for reading. Studies with patients who have had any prior ankle surgery, studies without full text, and studies with more than 20% of patients lost to follow-up are excluded.

2.3 Study quality assessment

Two reviewers (Qifan. Y and Jing. L) independently evaluated the quality of identified RCTs using the Cochrane Library's risk of bias(9), which included seven items: random number generation, concealment of allocation schemes, blinding of experimenters and participants, non-conforming result data, selective reporting, and other deviations. The studies were all categorized as low, unclear, or high risk. The senior author will decide on any differences between the two reviewers.

2.4 Data extraction

Two reviewers (Qifan. Y and Jing. L) independently collected all relevant data from the study in a predetermined way. Data in other formats (such as mean and range) should be translated to mean ± SD using the Cochrane Handbook Standard Deviation guidelines(10). The article data includes the first author's name, the year of publication, the study title, the sample size, and the follow-up date. The most prevalent demographic data points are average age, gender, and diagnosis. Clinical prognostic indicators include Foot and Ankle Prognosis Score (FAOS), Foot and Ankle Ability Measurement (FAAM), ankle joint stability, complications, and Karlsson-Peterson scores. The senior author decides whether there is a disagreement between the two reviewers.

2.5 Statistical analysis

Review Manager (Revman, Version 5.4, The Cochrane Collaboration) was used to analyze the data. For continuous data, mean difference(MD) and 95% CI intervals (95% CI) were calculated, whereas, for dichotomous data, odds ratios(ORs) and 95% CI were used. I² tests were employed to determine heterogeneity, with I² > 50% and P <0.10 indicating considerable heterogeneity. When significant heterogeneity was identified, a random-effect model was used; otherwise, a fixed-effect model was used. Statistical significance was defined as a P value of less than 0.05.

3.1 Literatureures review

After an initial search of relevant databases, 130 papers meeting the essential screening criteria were found, as shown in Fig. 1. The inclusion and exclusion criteria were applied to 22 research, and duplicate papers were deleted. Then 22 full texts were assessed for eligibility, and 8 RCTs with several 426 patients were included in this meta-analysis(4–6, 10–14).

3.2 Studies characterization

Table 1 illustrates the general information about the studies that were included. All of the randomized controlled trials were published between 1994 and 2021, with a one minimum follow-up time. A total of 426 patients with CLAI were included in the study, with 222 receiving Other operations treatment and 204 receiving MBG treatment. The average age of the two groups was not significantly different (P > 0.05). Figure 2 summarizes the findings of the quality assessment.

Table 1

Baseline data from the studies that were included.
Study	Country	Design	Other operations group			MBG group			Outcome	Measurement timepoint (month)
Study	Country	Design	Sample size	Age (year)	Female (%)	Sample size	Age (year)	Female (%)	Outcome	Measurement timepoint (month)
Tekin KU,2019	Australia	RCT, 2 arms	22	26.1 ± 8.3	54.55%	25	24.0 ± 6.9	52.00%	FAOS Score、Tegner Score	12、24、60
Porter M, 2019	Australia	RCT, 2 arms	21	26.1	48%	20	24	50%	FAOS Score	12、24
Porter M, 2014	korea	RCT, 2 arms	28	26.6	100%	27	28.1	100%	FAOS Score、FAAM Score、Anterior Talar Translation And Talar Tilt	3、24
KulWen R,2021	Korea	RCT, 2 arms	20	30.7	45%	20	33.9	40%	Karlsson Score、Sefton Score、Anterior Talar Translation And Talar Tilt	3、12、24
Karlsson J, 1997	Turkey	RCT, 2 arms	30	27.8		31	28.6		FAOS Score、 FAAM Score	12
Hennrikus WL, 1994	Sweden	RCT, 2 arms	30	24		30	24		Karlsson and Peterson Score、Tegner Score、Anterior Talar Translation And Talar Tilt	36
Cho BK, 2017	California	RCT, 2 arms	20	26	0%	20	25	29%	Sefton Score、Talar Tilt	29
Cho BK, 2012	USA	RCT, 2 arms	60	31.3 ± 15.5	54%	59	41.4 ± 14.0	78%	RTPAL、VR12M、VR12P、FAAM ADL、FAAM Sports、KP、VAS

3.3 Meta-analysis of outcome

3.3.1 FAOS – Pain, symptoms, activities of daily living (ADLs), sport, quality of life (QOL), and total scores

Pain

The FAOS pain score with SD was studied in four trials(4, 10, 13, 14), totaling 204 participants. The results showed that there was no considerable disparity (P= 0.23, I²= 23%). Hence the data was analyzed using the random-effects model. There was a significant difference in pain ratings between the Other operations and MBG groups (MD= 4, 95% CI: 1.91-6.08, P= 0.0002) in the summary data. The Other operations group had a better clinical score influence; Then, according to follow-up time, the Other operations group had a better clinical scoring effect. The data was broken down into subgroups and analyzed. First, 149 individuals in three studies(4, 13, 14)reported the FAOS pain score after being monitored for a year. Since there was no significant heterogeneity (P=0.16, I²=46), the findings were analyzed using the random-effects model. The pain scores of the Other operations and MBG groups were significantly different (MD = 6.24, 95 % CI: 3.16-9.32, P＜0.0001); When the follow-up time was two years, three items were significantly different. The study(10, 13, 14) included 143 patients who had FAOS with SD pain scores. The findings show no significant heterogeneity (P= 0.31, I²= 13%), and the data analysis is conducted using a random-effects model. The Other operations group outperformed the MBG group (MD = 4.46, 95 % CI: 2.02-6.90, P = 0.0003) (Fig. 3a).

Symptoms

The symptom elements of the FAOS score were reported as MD ± SD in four studies (204 individuals)(4, 10, 13, 14). Fig. 3b depicts the results. Heterogeneity is statistically significant (P≤ 0.00001, I² = 84%). The data analysis is completed using the random-effects model, and there is a distinction between the two groups (MD= 8.90, 95%CI: 5.57-12.22, P＜0.0001), with the Other operations group scoring higher (MD= 8.90, 95% CI: 5.57-12.22, P＜0.0001). Subgroup analysis based on follow-up time was used to determine the FAOS symptom score and SD; two studies(4, 14) with 87 patients reported the FAOS symptom score and SD at one year. Because there was no significant heterogeneity (P= 1.00, I²= 0%), the data were analyzed using the random-effects model. According to the summary data, there was a significant difference in symptom scores between the Other operations and MBG groups (MD= 9.50, 95%CI: 7.04-11.96, P＜0.00001). After a two-year follow-up period, 143 patients were involved in three trials(4, 10, 14). Because of the substantial heterogeneity (P= 0.0002, I² = 88% ), the data were analyzed using the random-effects model. The Other operations group had a higher score (MD= 9.20, 95% CI: 2.44-15.96, P = 0.01) than the MBG group (MD= 9.20, 95% CI: 2.44-15.96, P = 0.01) than the MBG group (MD = 9.20, 95 % CI: 2.44-15.96, P = 0.01).

ADLs

4 articles(4, 10, 13, 14) included 204 patients and provided the results of the FAOS ADL component in the form of MD ± SD for analysis. Due to the strong heterogeneity of the results (P = 0.003, I² = 65%), the random-effects model was used in the analysis, and the results revealed that the difference between the groups was not statistically significant (MD= 4.94, 95% CI: 1.77-8.10, P= 0.002). Following that, a subgroup analysis was performed. After a year of follow-up, 88 patients in two trials(4, 14) revealed no significant heterogeneity in the ADLS score of FAOS (P=1.00, I²=0%), and the data analysis was randomized Effect model. The ADLS scores of the Other operations and MBG groups were substantially different (MD= 7.80, 95%CI: 3.89-11.71, P＜0.00001), according to the summary results. Three trials(4, 10, 14) involved 143 patients when the period was two years. Because the data is highly heterogeneous (P = 0.03, I² = 72%), the random-effects model is used to examine it. According to the summary data, the difference in ADLS scores between the MBG and Other operations groups was not statistically significant (MD= 4.26, 95%CI: -1.90-10.41, P= 0.18). (Fig. 3c).

Sport

Data from four studies(4, 10, 13, 14) are provided for the FAOS sports scores. Because of the considerable heterogeneity (P ＜0.00001, I² = 92 %), we applied a random-effects model to examine the data and discovered that there was a statistical difference between the Other operations and MBG groups (MD= 10.80, 95%CI: 6.40-15.20, P ＜0.00001). For various periods, a subgroup assessment was conducted. A total of 88 patients in two investigations(4, 14) reported FAOS exercise scores after a year of follow-up, with no significant heterogeneity in the results (P=1.00, I²=0%). The data were analyzed using a random-effects model, which indicated a significant variation in Sports ratings between the Other operations and MBG groups (MD= -12.10, 95% CI: 10.00-14.20, P＜0.00001). The follow-up period was two years, with three items. There were 143 patients in the study(4, 10, 14). It has significant heterogeneity (P＜0.00001, I²= 93%), and data analysis is done using the random-effects model. The Other operations group outperformed the MBG group in Sports scores (MD= 10.25, 95% CI: 1.59-18.91, P=0.02), according to the summary data (Fig. 3d).

QOL

In four various studies, the FAOS QOL score was recorded. (4-8) Because the variability was significant (P＜ 0.00001, I²= 92% ), a random-effects meta-analysis was used, which can be seen in Fig.3e. There was a significant difference between the two groups (MD =10.80, 95% CI: 6.40–15.20, P＜0.00001). After a one-year follow-up period, two studies(4, 14)with 88 patients reported the FAOS QOL score with SD. The data were examined using a random-effect model because there was no substantial variation (P = 1.00, I²= 0%). There was a significant difference between the Other operations and MBG groups in terms of Sports score (MD= 12.10, 95%CI: 10.00-14.20, P＜ 0.00001). Three investigations(4, 10, 14) involving 143 patients were conducted after two years of follow-up. Because of the significant heterogeneity (P＜ 0.00001, I²= 93%), the data were analyzed using a random-effect model. The difference in QOL score between the Other operations and MBG groups was considerable (MD= 10.25, 95%CI: -0.38-20.26, P= 0.02), according to the pooled data.

Total scores

Four studies were selected for data synthesis in AFOS Total Scores(4, 10, 13, 14). We pooled the data using a random-effect model (Fig.3f) and discovered a significant difference (MD= -6.53, 95% CI: -12.98-0.08, P= 0.05) due to significant heterogeneity (P＜0.00001, I²= 92%). After one year of follow-up, two studies(4, 14) involving 88 people revealed total FAOS scores with SD. The statistical analyses were conducted using a random-effect model because there was no significant heterogeneity (P= 1.00, I²= 0%). Three studies(4, 10, 14) involving 143 patients found that the difference between MBG and Other operations groups was significant in terms of Total scores (MD=-9.50, 95%CI: -10.94– -8.06, P＜0.00001) during a two year follow-up period. The data were determined using a random-effect model due to the substantial heterogeneity (P= 0.0003, I²= 88%). The variation scores between the MBG and Other operations groups were notable (MD= -8.15, 95%CI: -13.20– -2.90, P= 0.002), according to the pooled data.

3.3. 2FAAM – Daily activity, sports activity, total scores

Daily activity

The Daily activity score of FAAM was reported in three trials involving 227 persons(10, 12, 13). Data synthesis was performed using a random-effects model because there was no substantial heterogeneity (P = 0.34, I²= 6%). In addition, there is no large discrepancy between the MBG and Other operations groups (MD= 2.47, 95%CI: -0.05–5.00, P = 0.05) Fig. 4a.

Sports activity

The Sports activity portion of FAAM scoring was also provided in three studies(10, 12, 13). Because there was a lot of heterogeneity (P= 0.09, I²= 59%), data synthesis was done with a random-effect model, which revealed no statistically significant difference between the two groups (MD= -0.42, 95%CI: -5.50– 4.66, P = 0.87), as shown in Fig 4b.

Total Scores

Regarding FAAM total scores, two studies provided valid data(10, 13). Because the data was highly diverse (P= 0.00001, I²= 96%), the meta-analysis was performed using a random-effect model, as shown in Fig 4c, with no notable discrepancies between the two groups (MD= 15.33, 95%CI: -7.21– 37.87, P = 0.18).

3.3.3 Ankle stability–Talar tilt angle and Anterior talar translation

Talar tilt angle

The Talar tilt angle was reported in five investigations(5, 6, 12, 15). We used a random-effect model to finish the data synthesis since there was no significant heterogeneity (P = 0.60, I²= 0%), and the distinction was not statistically significant (MD= -0.19, 95%CI: -1.25– 0.87, P= 0.72). Fig. 5a shows that after a three-month follow-up term, two investigations(10, 11) involving 95 patients reported the FAOS Total Score with SD. Because there was no significant variation (P= 0.28, I²= 13%), the data were collected using a random-effect model. Three investigations(4, 10, 13) comprising 156 patients found no significant variations in Talar tilt angle between MBG and Other operations groups after a year of follow-up (MD= -0.08.,95% CI: -2.03– -1.88, P= 0.94). The data were analyzed using the random-effect approach, and there was no considerable disparity (P= 0.61, I²= 0%). According to the combined results, there was no great disparity in Talar tilt angle between the MBG and Other operations groups (MD= 0.16, 95%CI: -1.56– -1.89, P= 0.85).

Anterior talar translation

Data on anterior talar translation was gathered from 193 people in four studies(6, 10, 11, 13). Considering the lack of heterogeneity (P= 0.59, I²= 0%), a random-effect model was used to merge the data, as seen in Fig 5b, and no statistical significance was found (MD= 0.26, 95%CI: -0.98– 1.51, P = 0.68). After a three-month follow-up period, two studies(10, 11) involving 95 patients reported a Sports score of FAOS with SD. The data were examined using a random-effect model because there was no considerable disparity (P =0.24, I²= 29%). In terms of anterior talar translation, there was no massive distinction between the MBG and Other operations groups (MD= 0.72, 95% CI: -0.58– 2.02, P = 0.28). After a year of follow-up, three investigations(4, 11, 13) with 156 participants were completed. Because there was no significant heterogeneity (P =0.43, I²= 0%), the data were analyzed using a random-effect model. There was no substantial distinction groups (MD= 0.64, 95%CI: -0.15–1.09, P= 0.22), according to the combined data (MD= 0.64, 95% CI: -0.15– 1.09, P= 0.22).

3.3.4 Karlsson-Peterson scale

Karlsson-Peterson scale data analysis was performed on two trials(11, 12) with a total of 151 participants. Because there was no statistical significance (MD= -1.67, 95%CI: -5.03– 1.69, P= 0.33) due to the lack of diversity (P= 0.23, I²= 31%), a random-effect model was employed to integrate the data, as shown in Fig. 6.

3.3.5 Postoperative complications

For the meta-analysis, four complications were chosen: infection, recurrence, irritation, and nerve injury. Fig. 7 depicts the final result. We found no significant discrepancies and completed the meta-analysis using the random-effect model to account for all problems. When assessing each complication, no statistical significance was identified between the two groups (MD= 0.84, 95% CI: 0.36– 12.01, P= 0.70).

Lateral ankle sprain (LAS) is a common disease for physically active people. It also has a high incidence in the general population. Conservative treatment procedures such as bracing and plaster fixing can heal about 80% of acute ankle sprains. CLAI continues to affect 20% of individuals(16). The expert panel agreed on five critical factors in terms of injury diagnosis. The following are some of them: (1) previous lateral ankle sprain; (2) etiology of injury; (3) weight-bearing status; (4)clinical evaluation of ligaments, and (5) clinical evaluation of bones(17); Delahunt et al. expanded the under-defined inclusion criteria in CLAI to classify people with mechanically and functionally unstable ankles. They clearly stated that: to be classified as CLAI, residual symptoms ("withdrawal" and a feeling of ankle instability) should be present at least one year after the initial sprain(18). Due to the high recurrence rate, patients, their families, and society need to bear a substantial medical burden(19). The diagnostic criteria are the difference between the lateral ankle joint and the opposite side when the talus is tilted 10° or more.

With the improvement of living standards, the number of people with heavy weights has gradually increased. After sprained ankle joints, higher requirements for its stability have been put forward. Ligament repair and reconstruction, as well as stenosis, are two of CLAI's ligament repair treatments. MBG surgery refers to suturing the upper bundle of IER to the lower fibular segment based on the MBG operation; it is one of the most often utilized surgical procedures to treat CLAI. Other operations covered in this article, such as The LARS procedure, were performed with two additional incisions. The proximal incision was utilized to bring the LARS loop up the fibular tunnel, while the distal one was used to secure the CFL limb of the LARS to the native insertion site on the calcaneum. A horizontal incision was made halfway between the tip of the lateral malleolus and the sole, in line with the posterior surfaces of the fibula. The distal attachment of the CFL was identified, and a 20 mm blind-ending tunnel was drilled for attachment of the CFL limb of the LARS, allowing the LARS ring to pass through the fibula tunnel from distal to proximal, and tensioning them separately to form a stable ankle joint under moderate restraint. Standard anteromedial, anterolateral, and auxiliary anterolateral portals were employed with AST. Make equidistant points at the distal fibula and the ATFL in the talar neck. Following preparation, a hole was drilled in the talar neck, and a suture tape-attached anchor was implanted. Reconstruction of the ligaments, as reported by Karlsson et al. is easy with transection, shortening, and imbrication of the remnants of the ATFL and CFL; the Chrisman-Snook procedure; uses one-half of the peroneus brevis tendon to repair calcaneal fibular ligaments and the anterior talofibular(14).

MBG cannot provide proper relaxation recovery due to poor ligament residues, so the external ligament reconstruction procedure is proposed. Regarding ligament reconstruction surgery, such as LARS, AST, etc. In the study of Hong Li et al., there are no substantial differences in risk of complications between Suture Tape Augmented repair and BR surgery; according to the researchers, the Suture Tape Augmented repair procedure seems to be a safe and fast option(20). However, in one study., it was found that the MBG had less anterior talar displacement and talar tilting than the Chrisman-Snook or the incised ligament groups at all forces. At intermediate-term follow-up, Tekin Kerem Ulku et al(13). found that lateral ankle ligament augmentation with suture tape was comparable to arthroscopic modified-Brostrom repair, with less operation time and no need for a cast or brace. However, William L. Henrik et al. believed that in virtually all patients, the modified-Brostrom treatment resulted in ankle joint stability with minimum morbidity. Nerve entrapment is uncommon, and overtightening of the lateral side of the ankle is uncommon(21). There were no significant changes in anterior talar displacement and talar tilt, according to Stephen H. Liu et colleagues. For CLAI with generalized ligamentous laxity, Other operations enhanced with suture tape appeared to be an effective alternative. MBG, on the other hand, imposes more mechanical constraints than any other software. It resulted in a more considerable mechanical restraint than the other techniques(15, 17). As a method to improve the clinical outcome of CLAI. Other operations surgery is now very mature; in addition, this method can meet the needs of more people.

There is no agreement on the appropriate scoring method for evaluating ankle stabilization surgery's clinical success(22). However, most studies used the American Orthopedic Foot and Ankle Association Ankle Hind Foot Scale (AOFAS) score, stress X-ray film, Sefton Grading System, and patient satisfaction score. The Karlsson-Peterson score was compared with the tendon fixation by reading related literature. Using the scoring technique outlined above, we compared the findings of the Other operations and MBG groups in this study. Regarding FAOS score, the Other operations group had a substantial edge. The Other operations group has more outstanding ankle joint function than the MBG group, according to the overall results. In terms of Tara's tilt angle and anterior translation, there was no difference between the two groups, and they all recovered to normal, showing that the two surgeries can restore the patient to normal anatomical alignment. Considering. Other operations can obtain better prognostic indicators than MBG since it is suitable for a wide variety of people and has a shorter postoperative fixed duration. According to the author, other operations could be an excellent option for treating CLAI.

For postoperative ankle stability evaluation, radiographs were used to measure the talar tilt angle under a 150 N varus stress and the anterior talar translation under the anterior drawer stress. The Talar Tilt Angle is the angle created by the distal tibia's articular surfaces and the talus's articular surface while under varus stress. The mean talar tilt angle and anterior talar translation of patients in the two groups were over 10° and 10 mm before surgery, indicating lateral ligament damage in the ankle joint. In both groups of patients, the talar tilt angle and anterior talar translation dropped to the normal range after surgery, suggesting that CLAI can be stabilized. Since Other operations apply to an extensive range of people and have a shorter postoperative fixed period, they can obtain better prognostic indicators than MBG. The author believes that Other operations can be a good choice for treating CLAI.

Because no considerable difference was discovered between the two groups in terms of postoperative functional rating, ankle stability evaluation, and complications after a thorough review of all the pooled results, the author feels that Other operations have an evident clinical advantage over the MBG group.

The current meta-analysis found no significant differences between Other operations and MBG operations regarding postoperative FAAM, ankle stability evaluation, or complications. Based on the findings, the author feels that Other operations surgery has clinical advantages over MBG surgery. While the data is favorable, due to the low methodological quality of RCTs, it is not conclusive. More high-quality RCTs with a low risk of bias and adequate sample numbers are needed to demonstrate its genuine effects.

1. CLAI: Chronic Lateral Ankle Instability, 2. MBG: The Modified Brostrom-Gould

Conflict of Interest statement

No potential conflict of interest was reported by the authors.

Funding

This study was supported by the National Natural Science Foundation of China (grant number: No12072129), Thanks for the financial support.

Acknowledgements

Dong. Z and Qifan. Y conceived the original ideas of this manuscript. Jing L, Qifan. Y screened out eligible studies separately. Lei. T discussed the controversial parts of literature screening and quality evaluation. Peng C. Z, Qifan. Y a Jing. L completed data collection and analysis and finished the manuscript. Dong. Z and Lei. T supervised the entire process and revised the manuscript. All authors have read and approved the manuscript.

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Reviewers agreed at journal
10 Jul, 2022
Reviewers invited by journal
08 Jul, 2022
Editor invited by journal
07 Jul, 2022
Editor assigned by journal
03 Jul, 2022
First submitted to journal
03 Jul, 2022

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Other operations Versus MBG Procedure of Chronic Lateral Ankle Instability: a systematic review and meta-analysis

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Figures

1 Introduction

2 Material And Method

2.1 Study selection and search strategy

2.2 Eligibility criteria

2.3 Study quality assessment

2.4 Data extraction

2.5 Statistical analysis

3 Results

3.1 Literatureures review

3.2 Studies characterization

3.3 Meta-analysis of outcome

3.3. 2FAAM – Daily activity, sports activity, total scores

3.3.3 Ankle stability–Talar tilt angle and Anterior talar translation

3.3.4 Karlsson-Peterson scale

3.3.5 Postoperative complications

4 Discussion

5 Study Strengths And Limitations

6 Conclusion

Abbreviations

Declarations

References

Status:

Version 1