Open vs. arthroscopic ankle arthrodesis: a comprehensive umbrella review of outcomes and complications

OBJECTIVE: End-stage ankle arthritis is a debilitating condition for which ankle arthrodesis (AA) remains a principal surgical option. Open and arthroscopic techniques are widely used, yet the literature presents heterogeneous findings. This umbrella review consolidates systematic reviews and meta-analyses to compare open vs. arthroscopic ankle arthrodesis in terms of fusion rates, complications, and hospital stay duration. MATERIALS AND METHODS: Following a registered protocol (PROSPERO ID: CRD420246233349), we searched articles on PubMed, Embase, and the Cochrane Library from November 2 to November 10, 2024. We included systematic reviews and meta-analyses in English comparing open and arthroscopic AA, capturing data on fusion rates, postoperative complications (e.g., nonunion, infection), and hospital stay. Quality was assessed with AMSTAR 2. A descriptive synthesis was chosen due to methodological heterogeneity. RESULTS: Eight systematic reviews encompassing 74 primary studies (4,631 total procedures) met the inclusion criteria. Fusion rates were consistently high but higher with arthroscopic techniques (range 88.7-95.1%) compared to open methods (range 78.5-85.0%), with odds ratios frequently around 2.0-3.3 favoring arthroscopy. Complication rates (e.g., infection, wound problems) were significantly lower in arthroscopic groups, typically 6-10% vs. 13-18.5% in open groups, corresponding to odds ratios of approximately 0.47-0.60 in favor of arthroscopy. Additionally, hospital stays were shortened by an average of 1.2-1.8 days with arthroscopic approaches, reflecting a weighted mean difference often exceeding -1.60 days. These findings were attributed mainly to the minimally invasive nature of arthroscopy, which reduces soft tissue disruption and expedites recovery. CONCLUSIONS: Arthroscopic ankle arthrodesis demonstrates superior outcomes over open techniques, offering higher fusion rates, fewer complications, and shorter hospital stays. Although open approaches remain viable, particularly for complex deformities, these data underscore the procedural and systemic advantages of arthroscopy in most clinical scenarios. Further research should aim to refine indications, optimize arthroscopic protocols, and investigate patient-specific factors - such as smoking status and comorbidities - that may influence surgical outcomes.

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