Abstract：
OBJECTIVE: Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories: allografts and autografts. This study aims to provide an updated comparison of the clinical outcomes after stabilisation procedures using allografts and autografts, to correctly advise the clinician during the choice of the best material to be used for the reconstruction of the lateral ligamentous complex of the ankle.
METHODS: A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient\'s subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures.
RESULTS: Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes.
CONCLUSIONS: The systematic analysis of validated CAI outcome measures and the patient\'s subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson-Peterson score superior to 80 points and to a similar rate of patient\'s subjective satisfaction.
METHODS: Level IV.
METHODS: A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient\'s subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures.
RESULTS: Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes.
CONCLUSIONS: The systematic analysis of validated CAI outcome measures and the patient\'s subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson-Peterson score superior to 80 points and to a similar rate of patient\'s subjective satisfaction.
METHODS: Level IV.
摘要：
目的：不同的移植物选择可用于重建踝关节外侧韧带以治疗慢性踝关节不稳（CAI），分为两类：同种异体移植物和自体移植物。这项研究旨在提供使用同种异体移植物和自体移植物进行稳定手术后的临床结果的最新比较。在选择用于重建踝关节外侧韧带复合体的最佳材料时，正确地建议临床医生。
方法：对CAI患者使用自体移植物和同种异体移植物进行踝关节外侧韧带复合体的解剖重建进行了系统评价。有必要通过结果测量进行术后评估，并在CAI人群或患者对治疗的主观评估中进行验证。通过改良的Coleman方法论评分（mCMS）评估纳入研究的质量。合并相关临床结果数据以提供不同组或不同程序后结果的综合描述。
结果：纳入了29项研究（自体移植：19；同种异体移植：9；两个程序：1），占930项程序（自体移植：616；同种异体移植：314）。平均mCMS为55.9±10.5点。Karlsson-Peterson量表是最常报告的结果量表，显示自体移植组（n=379，33.8个月随访）和同种异体移植组（n=227，25.8个月随访）的累积平均术前差异31.9分。在92.8％的自体移植物（n=333，65.2个月的随访）和92.3％的同种异体移植程序（n=153，25.0个月的随访）中，患者满意度良好或优异。手术后恢复活动和不稳定性复发在研究中的报道各不相同，这些结果突出表明同种异体移植物和自体移植物之间没有明显差异。
结论：对已验证的CAI结局指标和患者主观满意度的系统分析并不支持在CAI患者踝关节外侧韧带复合体重建中选择自体移植和同种异体移植。两种类型的移植术后Karlsson-Peterson评分高于80分，患者主观满意度相似。
方法：四级。
方法：对CAI患者使用自体移植物和同种异体移植物进行踝关节外侧韧带复合体的解剖重建进行了系统评价。有必要通过结果测量进行术后评估，并在CAI人群或患者对治疗的主观评估中进行验证。通过改良的Coleman方法论评分（mCMS）评估纳入研究的质量。合并相关临床结果数据以提供不同组或不同程序后结果的综合描述。
结果：纳入了29项研究（自体移植：19；同种异体移植：9；两个程序：1），占930项程序（自体移植：616；同种异体移植：314）。平均mCMS为55.9±10.5点。Karlsson-Peterson量表是最常报告的结果量表，显示自体移植组（n=379，33.8个月随访）和同种异体移植组（n=227，25.8个月随访）的累积平均术前差异31.9分。在92.8％的自体移植物（n=333，65.2个月的随访）和92.3％的同种异体移植程序（n=153，25.0个月的随访）中，患者满意度良好或优异。手术后恢复活动和不稳定性复发在研究中的报道各不相同，这些结果突出表明同种异体移植物和自体移植物之间没有明显差异。
结论：对已验证的CAI结局指标和患者主观满意度的系统分析并不支持在CAI患者踝关节外侧韧带复合体重建中选择自体移植和同种异体移植。两种类型的移植术后Karlsson-Peterson评分高于80分，患者主观满意度相似。
方法：四级。
