Alexandra J. Brown

Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review

PURPOSEnThe purpose of this systematic review was to evaluate the current studies on arthroscopic lateral ankle ligament repair for chronic lateral ankle instability.nnnMETHODSnA systematic search of MEDLINE, EMBASE, and Cochrane Library databases was performed during August 2017. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated.nnnRESULTSnEight studies for a total of 269 ankles were included; 87.5% of studies were LOE III or IV, and the QOE in all studies was of poor or fair quality. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores ranged from 41.2 to 69.9, and postoperative AOFAS scores ranged from 90.2 to 98. All studies using AOFAS score showed an increase in postoperative outcome score of 22.8 to 54.2 at a mean follow-up of 17.1xa0months. Five studies used Karlsson-Peterson scores with mean postoperative score of 88.5 (range, 76.2-93.6) at a mean follow-up of 21.2xa0months. The comparative studies showed similar clinical outcomes between arthroscopic and open procedures. The overall complication rate was 11.6% in the included studies. The overall rate of return to sport was 100%.nnnCONCLUSIONSnThe current systematic review demonstrated that arthroscopic lateral ankle ligament repair yields favorable clinical outcomes in the short term. However, there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure, and there are no long-term data currently available for the arthroscopic procedure. There was a relatively high complication rate (11.5%) associated with the arthroscopic procedures, although recent comparative studies demonstrated similar complication rates for both open and arthroscopic techniques.nnnLEVEL OF EVIDENCEnLevel IV, systematic review of Level I, III, and IV studies.

Arthroscopic versus open repair of lateral ankle ligament for chronic lateral ankle instability: a meta-analysis

Purpose The purpose of this meta-analysis was to analyze the current comparative studies of arthroscopic and open techniques for lateral ankle ligament repair to treat chronic lateral ankle instability. Methods A systematic search of MEDLINE, EMBASE and Cochrane Library databases was performed during February 2018. Included studies were evaluated with regard to level of evidence and quality of evidence using the Modified Coleman Methodology Score. Total number of patients, patient age, follow-up time, gender ratio, surgical technique, surgical complications, complication rate, recurrent instability or revision rate, clinical outcome measures and percentage of patients who returned to sport at previous level were also evaluated. Statistical analysis was performed using RevMan, and a p value of <u20090.05 was considered to be statistically significant. Results Four comparative studies for a total of 207 ankles were included. There was a significant difference in favor of arthroscopic repair with regard to AOFAS score, and there was no significant difference with regard to Karlsson score. There was a statistically significant difference in AOFAS score in favor of the arthroscopic repair (MD; 1.41, 95% CI 0.29–2.52, I 2 u2009=u20090%, p u2009<u20090.05). There was no statistically significant difference in Karlsson score (MD; 0.00, 95% CI −u20093.51 to 3.51, I 2 u2009=u20090%, n.s.). There was no statistically significant difference in total, nerve, or wound complications. Conclusions The current meta-analysis found that short-term AOFAS functional outcome scores were significantly improved with arthroscopic lateral ankle repair compared to open repair. There was no significant difference between arthroscopic and open repair with regards to Karlsson functional outcome score, total complication rate, or the nerve and wound complication subsets with the included studies with at least 12xa0months of follow-up. However, the current evidence is still limited, and further prospective trials with longer follow-up are needed. Level of evidence III.

Sesamoidectomy for Hallux Sesamoid Disorders: A Systematic Review

ABSTRACT Studies have shown that sesamoidectomy provides good clinical outcomes; however, concern exists regarding complications occurring after resection of 1 or both sesamoid bones. The purpose of the present systematic review was to evaluate the current evidence on sesamoidectomy for the treatment of hallux sesamoid disorders. A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed during October 2017. The included studies were evaluated for the level of evidence and quality of evidence using the Coleman Methodology Score. Variable reporting outcomes data, clinical outcomes, and percentage of patients returning to sports at their previous level were evaluated. Ten studies, totaling 196 feet, were included. The weighted mean patient age was 36.6 ± 11.0 years, and the weighted mean follow‐up duration was 45.1 ± 19.3 months. The mean visual analog scale score improved from 6.5 ± 0.3 to 1.2 ± 0.5. The mean postoperative American Orthopaedic Foot and Ankle Society ankle‐hindfoot scale score was 92.7 ± 2.7. Six studies demonstrated that 94.4% of patients returned to sports, with 90.0% returning to their previous level, at a mean of 11.8 ± 1.8 weeks. The mean hallux valgus angle increased from 13.1° ± 2.1° preoperatively to 14.8° ± 3.7° postoperatively (p = .470), and the mean intermetatarsal angle increased from 8.7° ± 0.8° to 9.7° ± 0.8° (p = .180). Overall complication rate was 22.5% and the revision rate was 3.0%. The present systematic review has demonstrated that sesamoidectomy for hallux sesamoids disorders yields good clinical outcomes and a high rate of return to sports in the short term, albeit with a high complication rate of 22.5%. &NA; Level of Clinical Evidence: 4

Osteochondral Allograft: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Osteochondral Allograft” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. Results: A total of 15 statements on osteochondral allograft reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support and 14 reached strong consensus (greater than 75% agreement). All statements reached at least 85% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with osteochondral allograft as a treatment strategy for osteochondral lesions of the talus.

Fixation Techniques: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle is based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Fixation Techniques” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; and unanimous, 100%. Results: A total of 15 statements on fixation techniques reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. All 15 statements achieved strong consensus, with at least 82% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with using fixation techniques in the treatment of osteochondral lesions of the talus.

Revision and Salvage Management: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article was to report on the consensus statements on “Revision and Salvage Management” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results: A total of 8 statements on revision and salvage management reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support and 7 reached strong consensus (greater than 75% agreement). All statements reached at least 85% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with revision and salvage management in the cartilage repair of the ankle.

Subchondral Pathology: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Subchondral Pathology” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results: A total of 9 statements on subchondral pathology reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. No statements achieved unanimous support, but all statements reached strong consensus (greater than 75% agreement). All statements reached at least 81% agreement. Conclusions: This international consensus statements regarding subchondral pathology of the talus derived from leaders in the field will assist clinicians in the assessment and management of this difficult pathology.

Scaffold-Based Therapies: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Scaffold-Based Therapies” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results: A total of 9 statements on scaffold-based therapies reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, 8 reached strong consensus (greater than 75% agreement), and 1 was removed because of redundancy in the information provided. All statements reached at least 80% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with applying scaffold-based therapies as a treatment strategy for osteochondral lesions of the talus. Level of Evidence: Level V, expert opinion.

Diagnosis: History, Physical Examination, Imaging, and Arthroscopy: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Diagnosis: History, Physical Examination, Imaging, and Arthroscopy” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus: 51 - 74%; strong consensus: 75 - 99%; unanimous: 100%. Results: A total of 12 statements on the diagnosis of cartilage injuries of the ankle reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Two achieved unanimous support and 10 reached strong consensus (greater than 75% agreement). All statements reached at least 86% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians in the diagnosis of cartilage injuries of the ankle.

Debridement, Curettage, and Bone Marrow Stimulation: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle

Background: The evidence supporting best practice guidelines in the field of cartilage repair of the ankle are based on both low quality and low levels of evidence. Therefore, an international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of the ankle. The purpose of this article is to report the consensus statements on “Debridement, Curettage and Bone Marrow Stimulation” developed at the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. Methods: Seventy-five international experts in cartilage repair of the ankle representing 25 countries and 1 territory were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 11 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed upon in unanimous fashion within the working groups. A final vote was then held, and the strength of consensus was characterized as follows: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimous, 100%. Results: A total of 14 statements on debridement, curettage, and bone marrow stimulation reached consensus during the 2017 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, 12 reached strong consensus (greater than 75% agreement), and 1 achieved consensus. All statements reached at least 72% agreement. Conclusions: This international consensus derived from leaders in the field will assist clinicians with debridement, curettage and bone marrow stimulation as a treatment strategy for osteochondral lesions of the talus.