Surgical treatment options for chronic instability of the peroneal tendons: a systematic review and proportional meta-analysis.

Autor: Lootsma J; Faculty of Medicine, KU Leuven-University of Leuven, Leuven, Belgium. joline.lootsma@outlook.com.; Center for Orthopedics, Trauma and Reconstructive Surgery, Rhein-Maas Klinikum, Würselen, Germany. joline.lootsma@outlook.com.; Boulevard du Midi 118, 1000, Brussels, Belgium. joline.lootsma@outlook.com., Wuite S; Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium.; Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, Leuven, Belgium.; Institute of Orthopaedic Research and Training, KU Leuven-University of Leuven, Leuven, Belgium., Hoekstra H; Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium.; Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium., Matricali GA; Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium.; Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, Leuven, Belgium.; Institute of Orthopaedic Research and Training, KU Leuven-University of Leuven, Leuven, Belgium.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2023 Apr; Vol. 143 (4), pp. 1903-1913. Date of Electronic Publication: 2022 Mar 09.
DOI: 10.1007/s00402-022-04395-4
Abstrakt: Introduction: Several surgical techniques for chronic instability of the peroneal tendons have been reported. Yet, the most optimal technique has not been clarified. This study aims to perform a systematic review and meta-analysis of all existing evidence and compare all published surgical techniques in both the athletic as the nonathletic population.
Materials and Methods: A systematic review and a proportional meta-analysis, with a random-effects model, were carried out according to the PRISMA guidelines, using the keywords "chronic luxation" OR "instability" AND "peroneal tendon" AND "treatment" OR "treatment protocol". Four surgical techniques were compared in patients with chronic peroneal instability, comprising superior peroneal retinaculum (SPR) repair or replacement, groove deepening procedures (primarily with additional SPR operations), rerouting procedures, and bony procedures (respectively group S, G, R and B). Outcomes of interest include the pre- and postoperative American orthopedic foot and ankle society hindfoot score, return to sports, postoperative redislocation and complications. Pooled estimates of the last two outcomes were obtained.
Results: For the systematic review, 31 studies were eligible. Of these, 25 papers met the criteria for inclusion in the meta-analysis. All techniques demonstrated a clinical improvement postoperatively. Group B, however, demonstrated overall more unsatisfactory results, and higher complication rates were observed for both group R and group B. The latter was established by the proportional meta-analysis as well [95% confidence interval group S: (0.01-0.10); group G: (0.02-0.10); group R: (0.13-0.57); group B: (0.24-0.40)]. Concerning surgical efficacy (= no postoperative redislocation), no significant difference was statistically observed. Finally, considerable differences in study quality were identified.
Conclusion: Surgical treatment results in excellent clinical and functional outcomes in patients with chronic peroneal instability. More inferior results were demonstrated for rerouting and bony procedures. However, no high-quality studies are available and future randomized controlled trials are necessary to advocate for the most advantageous approach.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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