Network meta-analysis of different anatomical repair strategies to improve chronic lateral ankle instability / 中国组织工程研究

ABSTRACT

OBJECTIVE:At present,there are various surgical repair strategies for the lateral stability of chronic ankle instability after the injury of the lateral collateral ligament of the ankle,but the specific repair strategy to maximize the recovery of lateral stability of the ankle still lacks of evidence-based medical evidence.Based on this,for the first time,this paper systematically evaluated the effects of four popular repair strategies to restore the lateral stability of chronic ankle instability using the network meta-analysis method. METHODS:Computer retrieval was conducted on CNKI,WanFang,VIP,PubMed,Embase,Web of Science and Cochrane Library.The retrieval time was from the establishment of each database to December 2022.The randomized controlled trials or clinical controlled trials on different repair strategies to recover chronic ankle instability after injury of the lateral ligament of the ankle were included.The literature was screened and extracted.The literature quality was evaluated and data were analyzed using RevMan 5.4,R4.2 and Stata 14.2 software. RESULTS:Twelve studies(including 10 randomized controlled trials and 2 cohort studies)were included.A total of 673 patients with chronic ankle instability were involved in 4 repair strategies.The observation indicators were:anterior talar translation distance and talar tilt angle of ankle joint stress X-ray film(hereinafter referred to as anterior talar translation distance and talar tilt angle).The results of network meta-analysis showed that:(1)In terms of anterior talar translation distance,the sequence of reticular meta-analysis results from inferior to superior was anatomical repair>anatomical repair + enhancement of inferior extensor retinaculum>internal brake anatomical reconstruction>autologous/allogeneic tendon anatomical reconstruction.(2)In terms of talar tilt angle,the sorting results of reticular meta-analysis from inferior to superior were as follows:anatomical repair>anatomical repair + inferior extensor retinaculum enhancement>internal brace anatomical reconstruction>autologous/allogeneic tendon anatomical reconstruction. CONCLUSION:Anatomical reconstruction strategy of autologous/allogeneic tendon is the first in improving anterior talar translation distance and talar tilt angle,suggesting that this strategy may have the best effect in restoring the stability of chronic joint instability after injury of the lateral ligament of ankle,but more large sample,multicenter,double-blind randomized controlled trials are still needed in the future to further confirm.