Today, I'll be discussing our paper entitled Clinical Outcomes of Anatomical Reconstruction of the Lateral Ankle Ligament Complex, a Systematic Review. These are our relevant disclosures. Approximately 20-40% of patients who sustain an acute ankle sprain will end up developing chronic lateral ankle instability. This debilitating pathology is most frequently managed with anatomical repair via Brostrom-Gould procedure. However, in patients with poor ligament quality or generalized ligamentous laxity, repair with anatomical reconstruction is often indicated. However, there appears to be a lack of consensus regarding optimal surgical management technique and associated clinical outcomes following anatomical reconstruction for chronic lateral ankle instability. The purpose of our study was to assess and evaluate the current evidence available for clinical outcomes, radiological outcomes, complication rates, and revision rates following anatomical reconstruction for chronic lateral ankle instability. PubMed, Embase, and Cochrane Library databases were systematically searched in October 2019. The inclusion criteria included therapeutic clinical studies evaluating anatomical lateral ankle ligament reconstruction, studies with a cohort of at least 10 patients with a follow-up of at least 2 years that were published in a peer-reviewed journal in English language with the full-text version available. Exclusion criteria included review articles, case reports, technique articles, cadaveric studies, animal studies, and in vivo studies. The level of evidence for each study was assessed by criteria published in the journal Bone and Joint Surgery, and the quality of evidence was measured by the modified Kullman methodological score. Extracted clinical and radiological outcomes, complications, revision rates, and return to sport were documented. Our research led to 13 studies being included, of which typically had a low level of evidence with one study having a level of evidence 2, four studies having a level of evidence 3, and eight studies having a level of evidence 4. The quality of evidence was also poor, with a mean modified Kullman methodological score of 55.6. In total, there were 296 ankles that were included, of which 154 underwent autograft procedures, 142 underwent allograft procedures, the mean age was 30.2 years, and the mean follow-up was 33.1 months. Our review found that regardless of the subjective clinical scoring tool utilized, there were similar improvements in subjective clinical outcomes between both the autograft and allograft cohorts. In addition, we found that there were similar improvements in tailored tilt and anterior draw tests between the autograft and allograft cohorts. We found that the return to sport percentage was higher in the patients who underwent autograft procedures. We found a similar complication rate between the autograft and allograft cohort of approximately 7%. The most common complication reported in the autograft cohort was donor site morbidity, and the most common complication found in the allograft cohort was overtightened ligaments. So in conclusion, we found that anatomical reconstruction of chronic lateral ankle instability resulted in favorable clinical and radiological outcomes with low complication revision rates and excellent return to sport rates at short-term follow-up. There is no definitive evidence to suggest superiority of autograft over allograft or vice versa. Our study indicates that further prospective randomized control trials were required to determine the optimal operative technique. Thank you.

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clinical outcomes

anatomical reconstruction

lateral ankle ligament complex

chronic lateral ankle instability