REVIEW article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1572345
This article is part of the Research TopicMultidisciplinary Insights into Distal Tibiofibular Joint Injuries: An Integrative Analysis of Surgical Techniques, Rehabilitation Protocols, and Podiatric InterventionsView all 3 articles
Chronic Ankle Instability: A Meta-Analysis and Systematic Review Comparing Clinical Outcomes of Anterior Talofibular Ligament Repair With or Without Reinforcement of the Lower Extensor Retinaculum
Provisionally accepted
- 1Peking University, Beijing, China
- 2Suqian First People's Hospital, Suqian, Jiangsu Province, China
- 3China-Japan Friendship Hospital, Beijing, Beijing Municipality, China
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Background: 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. Methods: 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. Results: Our metaanalysis 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], p = 0.03 I2:0%, p = 1.000).Similarly, the reinforcement of IER showed a low correlation with Karlsson scores (mean difference -0.15 [-2.25, 1.96], p = 0.89; I2: 48%, p = 0.07) . The results for talar tilt (mean difference -0.11° [-0.37, 0.15], p = 0.42; I2:0%, p = 0.87) and anterior talar translation (mean difference 0.09mm [-0.10, 0.29], p = 0.34; I2:0%, p = 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.Conclusions: 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 of Evidence: Level Il, systematic review of Level II studies.
Keywords: Anterior talofibular ligament (ATFL), Meta - analysis, Inferior extensor retinaculum, Chronic ankle instability, Ankle sprains
Received: 07 Feb 2025; Accepted: 01 May 2025.
Copyright: © 2025 Liu, Li, Mengran, Zhou, Wang and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Bailiang Wang, China-Japan Friendship Hospital, Beijing, 100029, Beijing Municipality, China
Jinhui Ma, China-Japan Friendship Hospital, Beijing, 100029, Beijing Municipality, China
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