Arthroscopic Versus Open Ankle Arthrodesis: A Systematic Review

Purpose: To perform a systematic review comparing the clinical scores, union rate, complications, reoperations, hospital stay, and operation time between open ankle arthrodesis (OAA) and arthroscopic ankle arthrodesis (AAA). Methods: We conducted a comprehensive search in the MEDLINE, Embase, and Cochrane Library databases. Only comparative studies were included in this meta-analysis. The literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. The outcomes analyzed included clinical scores, union rate, complications, reoperations, hospital stay, operation time, and intraoperative blood loss. Results: A total of 7 retrospective comparative studies were included in this systematic review. Clinical scores were noted in 3 studies. The American Orthopaedic Foot & Ankle Society ankle-hindfoot score and the Ankle Osteoarthritis Scale score were better in the AAA group than in the OAA group. The union rate was similar between the OAA (70%-100%) and AAA (76.2%-100%) groups. The complication rate was higher in the OAA group (6.7%-47.1%) than in the AAA group (0%-23.8%) in 6 studies. The reoperation rate was similar between the OAA (0%-26.5%) and AAA (0%-27.6%) groups. The hospital stay was shorter in the AAA group in 6 studies. Among the 5 studies that reported operation time, 4 reported no significant difference. Two studies showed that intraoperative blood loss was significantly less in the AAA group. Conclusions: AAA was shown to offer the advantages of better clinical scores, fewer complications, a shorter hospital stay, and less blood loss compared with OAA. However, the union rate, reoperation rate, and operation time were similar overall between the 2 groups. Level of Evidence: Level III, systematic review of Level III studies.