title: Minimally invasive surgical treatment for chronic ankle instability: a systematic review.
abstract: OBJECTIVE
  The purpose of this study was to determine the evidence-based support for the treatment for chronic ankle instability (CAI) using minimally invasive surgery (MIS) techniques.
  
  
  METHODS
  A systematic comprehensive review of the literature was performed on 4 September 2015 using PubMed, EMBASE, Cochrane databases and Web of Science along with the two search concepts: lateral ligament of the ankle (patients) and minimally invasive surgical procedure (intervention). Articles of clinical study on MIS for CAI were included in this review and classified into four MIS categories (arthroscopic repair, non-arthroscopic minimally invasive repair, arthroscopic reconstruction and non-arthroscopic minimally invasive reconstruction) based on the adopted surgical procedure. Included articles were reviewed and assigned a classification according to the research method quality of evidence (Level I-V evidence). Analysis of these studies was then conducted to provide a grade of recommendation for each MIS category.
  
  
  RESULTS
  The systematic literature review generated 430 articles, and 33 articles met our inclusion criteria. The highest recommendation was Grade C (poor-quality evidence) to support the use of the arthroscopic repair, arthroscopic reconstruction and non-arthroscopic minimally invasive reconstruction. Insufficient evidence was currently available to make any recommendation (Grade I) for non-arthroscopic minimally invasive repair category.
  
  
  CONCLUSIONS
  Despite recent increases in publications on MIS for the treatment for CAI, there was currently poor quality of evidence that was insufficient to allow a high grade of recommendation to support the use of the MIS. This paper should stimulate those surgeons performing higher quality studies in the form of prospective and preferably randomized comparative studies that will be necessary to allow better recommendations for the treatment for CAI with MIS. The present study showed thorough evidence-based recommendation for the clinical use of the MIS based on the comprehensive review of the literature.
  
  
  METHODS
  Systematic review, Level IV.
authors: Queen Elizabeth II Health Sciences Center Halifax Infirmary, Dalhousie University, 1796 Summer Street Halifax, Nova Scotia, B3H3A7, Canada. kenor@nifty.com.|Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan. kenor@nifty.com.
authors: Kentaro
authors: K
authors: Matsui
authors: Queen Elizabeth II Health Sciences Center Halifax Infirmary, Dalhousie University, 1796 Summer Street Halifax, Nova Scotia, B3H3A7, Canada.
authors: Bernard
authors: B
authors: Burgesson
authors: Department of Orthopaedic Surgery, Teikyo Institute of Sports Science and Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan.|Department of Sport and Medical Science, Teikyo Institute of Sports Science and Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan.
authors: Masato
authors: M
authors: Takao
authors: Medical College of Wisconsin, Milwaukee, WI, USA.
authors: James
authors: J
authors: Stone
authors: Sport's Medical Clinic of Bordeaux, Bordeaux-Mérignac, France.
authors: Stéphane
authors: S
authors: Guillo
authors: Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), Dalhousie University, 1796 Summer Street Halifax, Nova Scotia, B3H3A7, Canada.
authors: Mark
authors: M
authors: Glazebrook
mesh_terms: D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy; D001265:Athletic Injuries / Q000601:surgery; D002908:Chronic Disease; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000293:injuries / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies
keywords: Ankle instability; Ankle lateral ligament; Arthroscopy; Minimally invasive surgery; Systematic review