Evidence-based indications for ankle arthroscopy.
OBJECTIVE
The purpose of this study was to review the literature to provide a comprehensive description of the Level of Evidence available to support the surgical technique of ankle arthroscopy for the current generally accepted indications and assign a grade of recommendation for each of them.


METHODS
A comprehensive review of the literature was performed (in August 2008) by use of the PubMed database. The abstracts from these searches were reviewed to isolate literature that described therapeutic studies investigating the results of different ankle arthroscopic treatment techniques. All articles were reviewed and assigned a classification (I-IV) of Level of Evidence. An analysis of the literature reviewed was used to assign a grade of recommendation for each current generally accepted indication for ankle arthroscopy.


RESULTS
There exists fair evidence-based literature (grade B) to support a recommendation for the use of ankle arthroscopy for the treatment of ankle impingement and osteochondral lesions and for ankle arthrodesis. Ankle arthroscopy for ankle instability, septic arthritis, arthrofibrosis, and removal of loose bodies is supported with only poor-quality evidence (grade C). Treatment of ankle arthritis, excluding isolated bony impingement, is not effective and therefore this indication is not recommended (grade C against). Finally, there is insufficient evidence-based literature to support or refute the benefit of arthroscopy for the management of synovitis and fractures (grade I).


CONCLUSIONS
There exists adequate evidence-based literature to support the surgical technique of ankle arthroscopy for most current generally accepted indications; however, further studies in this area are needed.


METHODS
Level IV, systematic review.
Glazebrook
Mark A
MA
Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. Mark.Glazebrook@cdha.nshealth.ca
Ganapathy
Venkat
V
Bridge
Michael A
MA
Stone
James W
JW
Allard
Jean-Pascal
JP
D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D017410:Practice Guidelines as Topic