title: Arthroscopic repair of lateral ankle ligament complex by suture anchor.
abstract: OBJECTIVE
  Arthroscopic repair of the lateral ligament complex with suture anchors is increasingly used to treat chronic ankle instability (CAI). Our aims are (1) to analyze and evaluate the literature on arthroscopic suture anchor repair of the anterior talofibular ligament and (2) to conduct a systematic review of the clinical evidence on the reported outcomes and complications of treating CAI with this technique.
  
  
  METHODS
  We performed a systematic review of the literature using PubMed, Ovid, Elsevier ScienceDirect, Web of Science-Conference Proceedings Citation Index, and the Cochrane Database of Systematic Reviews from 1987 to September 2013. Clinical studies using the arthroscopic suture anchor technique to treat CAI were included. Outcome measures consisted of clinical assessment of postoperative ligament stability and complications. In addition, the methodologic quality of the included studies was assessed by use of the modified Coleman Methodology Score.
  
  
  RESULTS
  After reviewing 371 studies, we identified 6 studies (5 retrospective case series and 1 prospective case series, all Level IV) that met the inclusion criteria, with a mean Coleman Methodology Score of 71.8 ± 7.52 (range, 63 to 82). In these studies 178 patients (179 ankles) underwent arthroscopic suture anchor repair of the anterior talofibular ligament with a mean follow-up period of 38.9 months (range, 6 to 117.6 months). All patients were reported to have subjective improvement of their ankle instability, with complications in 31 cases.
  
  
  CONCLUSIONS
  Studies of arthroscopic suture anchor technique to treat CAI are sparse, with moderate mean methodologic quality. The included studies suggest that the arthroscopic technique is a feasible procedure to restore ankle stability; however, on the basis of our review, this technique seems to be associated with a relatively high complication rate. Extensive cadaveric studies, clinical trials, and comparative studies comparing arthroscopic and open repair should be performed in the future.
  
  
  METHODS
  Level IV, systematic review of Level IV studies.
authors.affiliation: Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China.
authors.forename: Jingwei
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China. Electronic address: hua023@hotmail.com.
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Hua
authors.affiliation: Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China.
authors.forename: Shiyi
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China.
authors.forename: Hongyun
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China.
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D053441:Suture Anchors / Q000009:adverse effects; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult