Fair evidence consistently supports open surgical treatment for chronic ankle instability: a systematic review
Bibliographic record
Abstract
What is already known► Open procedures have been the mainstay of surgical treatment of chronic ankle instability for many decades.► Reports of novel minimally invasive and arthroscopic techniques have increased in recent years.► A recent systematic review identified only poor-quality evidence in support of minimally invasive surgical approaches to chronic ankle instability.What are the new findings ► The results of this study demonstrate the paucity of high-quality evidence in support of open operative procedures for the treatment of chronic ankle instability (CAI).► This systematic review helps reassure clinicians of their current practice, but emphasises the need for future high-quality evidence to support the use of open operative techniques for CAI.AbSTrACT Importance Patients with chronic ankle instability (CAI) who have failed non-operative treatments are most commonly treated with open ankle repair or reconstruction of the anterior talofibular ligament and/or calcaneofibular ligament.Over 50 operative techniques have been described for the treatment of CAI.However, there is no current systematic evaluation of currently used open operative techniques for the treatment of CAI.Aim/Objective The primary objective of this study is to provide evidence-based treatment recommendations for CAI in adults based on a comprehensive systematic review of the literature.Evidence review The literature review of PubMed, EMBASE, Cochrane and Web of Science databases was completed on 22 February 2017.Search terms included two concepts: lateral ligament of the ankle (patients) and open reconstructive or repair procedures (intervention).All published clinical studies with English translation were included.Biomechanical, cadaveric, review articles, minimally invasive procedures and arthroscopic procedures were excluded.Open operative procedures from included articles were classified as anatomical or non-anatomical and repair or reconstructive.Articles were then assigned a level of evidence (I-V) to denote quality of the research methods.Articles were reviewed collectively to provide a grade of recommendation (A-C or I) in support for or against the operative intervention in treatment of CAI.Findings Seventy one of 1635 identified articles were included for review.There is fair evidence (Grade B) in support of anatomical repair, anatomical reconstruction and non-anatomical reconstruction procedures.There was insufficient evidence available to grade internal brace and non-anatomical repair procedures.Conclusions and relevance Although only fair-quality evidence exists in support of open operative treatment of CAI, this systematic review helps reassure clinicians of their current practices.The literature reaffirms support for open anatomical repair and anatomical reconstruction technique for CAI.Level of evidence Level II, systematic review.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.065 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.008 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".