Chronic lateral ankle instability: A systematic review on comparison between operative treatments

Chronic lateral ankle instability (CLAI) is characterized by recurrent ankle sprains.Conservative treatment may result in persistent instability requiring operative management.Surgical treatments such as the Modified Brostrom-Gould (MB) procedure with and without suture tape ligament augmentation (+ST) have become effective at strengthening and/or supplementing repair.However, there is little evidence regarding a superior technique regarding cost-benefits for patients receiving either treatment.This review performed a comparative cost analysis between these procedures using Web of Science, PubMed, and Scopus databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.A total of 3 studies (257 ankles) met the inclusion criteria.Of the four groups (open MB, arthroscopic MB, MB+ST, MB+Mason-Allen), the MB+Mason-Allen suture technique appeared to be the most cost-effective, owed to shorter operating times and the use of only one suture anchor.There was no significant difference in post-operative Patient Reported Outcome Scores (PROMS) using AOFAS scores.However, there was a significant difference in the aggregate cost for patients who had open Brostrom-Gould and arthroscopic Brostrom-Gould, with open being overall lower cost.Furthermore, the MB group was $2,219 more expensive than the MB+ST (FiberTape internal brace augmentation ($20,970 vs. $18,751)) groups.Overall, utilizing an open technique (as opposed to arthroscopic), only placing one suture anchor (via Mason Allen configuration repair), and well-indicated internal brace utilization offer advantageous cost-efficacy in lateral ankle ligamentous stabilization.However, these findings should be interpreted cautiously and thoroughly considered due to the paucity of data on reported studies.