Single anchor versus double anchor for arthroscopic anterior talofibular ligament repair: A systematic review and mate-analysis of cohort studies.

Purpose: To determine whether a double anchor is more effective than a single anchor in the surgical repair of the anterior talofibular ligament (ATFL) in patients with ankle instability.

Methods: This study searched PubMed, Embase and the Cochrane Library to identify potential studies that compared the clinical outcomes of double anchors and single anchors for ATFL repair from inception to July 31st, 2023. The study aligned with the 2020 Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and checklist. The Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tool was used to evaluate methodologic quality and risk of bias. The meta-analysis was performed with random effects. Outcomes, including American Orthopaedic Foot & Ankle Society Score (AOFAS), Karlsson Ankle Functional Score (KAFS), Tegner activity score, return to sport rate, complications and revision surgery events, were recorded.

Results: A total of 845 articles were identified after an initial search of the three databases. Four retrospective studies involving 231 individuals were included for further analysis. There was no significant difference between the single-anchor group and the two-anchor group in terms of the AOFAS (risk ratio, -0.44, [-2.22; 1.34]) or KAFS (mean difference, -2.81, [-6.87; 1.25]). However, in terms of the Tegner activity score and the return to sport rate, the single-anchor group had significantly lower scores and longer times than the double-anchor group. No complications or revision surgery events were reported.

Conclusions: In patients with chronic ankle instability, both single anchors and double anchors can provide good functional outcomes. For patients who participate in physically demanding sports, double anchors may be a superior option.

Level of evidence: Level Ⅲ, meta-analysis of Level Ⅲ.