CC2023: Current Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review (August 2023)-Current Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review (August 2023)

Current Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review (August 2023)

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The systematic review "Current Definitions of Failure in Lateral Ankle Instability Surgery" aims to identify and standardize the definitions of failure for surgical treatments of lateral ankle instability (LAI). Conducted at the University of Kansas, the study reviewed literature from multiple databases, analyzing 42 clinical studies from 1984 to 2021.<br /><br />LAI, often resulting from recurrent ankle sprains, is a prevalent condition that can lead to chronic instability. Surgical treatment is usually recommended when nonoperative management fails. However, there's no consensus on what constitutes surgical failure, leading to varying reported failure rates.<br /><br />From the 1200 initial studies, only 3.5% met inclusion criteria. The most commonly used surgical technique was the anatomic Broström-Gould method, and definitions of failure varied widely. The most frequent criteria for failure included recurrent instability (40%) and rerupture (19%). Reported failure rates for the Broström-Gould technique fluctuated between 1.1% and 45.2%, depending on the definition used.<br /><br />The study found that the lack of a standardized definition for surgical failure complicates comparative analysis and consensus on optimal treatment methods. Definitions of failure have evolved to include subjective patient-reported outcomes, objective physical examination, and imaging findings, but they remain inconsistent.<br /><br />The authors recommend developing a uniform, standardized definition incorporating several facets: history, physical examination findings, outcome scores, imaging results, and surgical outcomes. This would aid in improving patient outcomes and enable better comparison of surgical techniques.<br /><br />Key recommendations for standardizing the definition of failure include specific physical assessment criteria for static and dynamic stability, the use of reliable dynamic stability tests like the Star Excursion Balance Test (SEBT), and validated patient-reported outcome measures such as the Foot and Ankle Ability Measure (FAAM). The study emphasizes that achieving a clear, consistent definition is essential for more accurate documentation and treatment of LAI, ultimately improving clinical care and patient outcomes.

Keywords

Lateral Ankle Instability

Surgical Failure

Broström-Gould Technique

Recurrent Instability

Rerupture

Standardized Definition

Patient-Reported Outcomes

Dynamic Stability Tests

Foot and Ankle Ability Measure

Clinical Outcomes