A comparison of the modified Brostrom procedure and modified Karlsson procedure in treating chronic lateral ankle instability: a systematic review and meta-analysis

Background: This study sought to compare the efficacy and surgery complications of the modified Brostrom procedure and the modified Karlsson procedure in treating patients with chronic lateral ankle instability (CLAI). Methods: Full-text publications on the clinical efficacy of Brostrom's and Karlsson's procedures were retrieved from multiple databases. Review Manager 5.0 was adopted for the meta-analysis, sensitivity analysis, and bias analysis. Results: Nine studies comprising a total of 643 patients were identified. The meta-analysis suggested that the American Orthopedic Foot and Ankle Society (AOFAS) scores of patients in the Karlsson group were higher than those of patients in the Brostrom group [mean deviation (MD) =6.31, 95% confidence interval (CI): 2.31-10.30, P=0.002; P for heterogeneity <0.00001, I-2=58%]. The Tegner scores of patients in the Karlsson group were higher than those of patients in the Brostrom group (MD =0.72, 95% CI: 0.48-0.95, P=0.24; P for heterogeneity <0.00001, I-2=23%). Operation times in the Brostrom group were higher than those in the Karlsson group (MD =-15.50, 95% CI: -19.98-11.02, P<0.00001; P for heterogeneity <0.00001, I-2=63%). Patients in the Karlsson group had higher levels of satisfaction than those in the Brostrom group (MD =0.63, 95% CI: 0.47-0.79, P<0.00001; P for heterogeneity =0.91, I-2=0%). No significant difference was observed in surgery complications between the Karlsson and Brostrom groups [odds ratio (OR) =1.71, 95% CI: 0.79-3.71, P=0.18; P for heterogeneity =0.99, I-2=0%]. Discussion: Based on the heterogeneity analysis results, this study showed that Karlsson's procedure was more efficient and safer than Brostrom's treatment in the treatment of CLAI patients.