Comparison of All-Inside Arthroscopic and Open Techniques for the Modified Broström Procedure for Ankle Instability.
BACKGROUND
No reported study has compared clinical and radiologic outcomes between an all-inside arthroscopic modified Broström operation (MBO) and an open MBO. The purpose of this study was to compare clinical and radiologic outcomes of all-inside arthroscopic and open MBOs.


METHODS
From August 2012 to July 2014, 48 patients were included. They were divided into 2 groups: all-inside arthroscopic MBO (25 patients) and open MBO (23 patients). The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) score, and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. MBO was performed in 87 patients. Of these, 50 patients met the inclusion criteria. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Patients were randomized into 2 groups, all-inside arthroscopic MBO and open MBO, using a permuted block randomization method. Clinical outcome evaluations were performed preoperatively, at 6 weeks and 6 months postoperatively, and at a final follow-up at a minimum of 12 months postoperatively using the Karlsson score, the AOFAS ankle-hindfoot score, and pain VAS scores. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle.


RESULTS
After randomization, 25 ankles were allocated to the all-inside arthroscopic MBO group and 25 to the open MBO group. Two ankles in the open MBO group were excluded from the analysis because they were lost to follow-up. Thus, evaluations were performed for 25 ankles in the all-inside arthroscopic MBO group and 23 in the open MBO group. There was no difference in age, gender, symptom duration, preoperative AOFAS, VAS, Karlsson scores, anterior talar translation, or talar tilt between the 2 groups (all P > .05). At the final follow-up, the AOFAS, VAS, and the Karlsson scores had improved significantly in both groups (P < .001). There was no difference in the Karlsson, AOFAS, or VAS scores, anterior talar translation, or talar tilt between the 2 groups at final follow-up (all P > .05).


CONCLUSIONS
There was no difference in the clinical or radiologic outcome between the all-inside arthroscopic MBO and open MBO for the treatment of lateral ankle instability at up to 1 year after surgery. An all-inside arthroscopic MBO should be considered carefully in patients who have lateral ankle instability.


METHODS
Level I, randomized controlled trial.
Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea.
Eui Dong
ED
Yeo
Foot and Ankle Clinic, KT Lee's Orthopedic Hospital, Republic of Korea.
Kyung-Tai
KT
Lee
Department of Orthopedics, Hanyang University Hospital, Republic of Korea.
Il-Hoon
IH
Sung
Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Republic of Korea.
Sun Geun
SG
Lee
Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Republic of Korea brain0808@hanmail.net.
Young Koo
YK
Lee
D000328:Adult; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
all-inside arthroscopic modified Broström operation; chronic lateral ankle instability; open modified Broström operation