Abstract
BACKGROUND: Previous evidence indicates disparities between the recovery of motor function in surgically treated ankle fractures and the functional performance of healthy individuals. However, no systematic review has quantitatively examined these functional differences. This study aimed to summarize and evaluate differences in gait analysis outcomes, muscle strength, and plantar pressure between postoperative ankle fracture patients and healthy controls. DATA SOURCES: A comprehensive electronic search was conducted in PubMed, EMBASE, the Cochrane Library, and Web of Science up to February 2024. Keywords included Ankle Fractures, Gait Analysis, Muscle Strength, Plantar Pressure, and Rehabilitation. STUDY SELECTION: Inclusion criteria were based on the PICOS principle. Eligible studies included cross-sectional and non-randomized observational studies comparing gait analysis outcomes, muscle strength, and plantar pressure between postoperative ankle fracture patients and healthy controls. DATA EXTRACTION: Extracted gait parameters included walking speed, peak dorsiflexion angular velocity, peak plantarflexion angular velocity, step length, single support time, and cadence. Muscle strength measures included peak torque of dorsiflexion and plantarflexion, as well as the cross-sectional area (CSA) of thigh muscles. Plantar pressure outcomes included mean and peak plantar pressure and contact time. Risk of bias was assessed using the Agency for Healthcare Research and Quality (AHRQ) tool and the Methodological Index for Non-Randomized Studies (MINORS). DATA SYNTHESIS: Heterogeneity among studies was assessed using Cochrane's Q test and the I(2) statistic. Subgroup analyses based on age, fracture diagnosis, and study designs were performed to explore potential sources of heterogeneity. Publication bias was evaluated using funnel plots, Egger's regression test, and Begg's test. Sensitivity analysis was performed using the leave-one-out method. RESULTS: Twelve studies comprising 219 postoperative ankle fracture patients and 192 healthy controls were included. Compared with healthy controls, postoperative ankle fracture patients showed significant impairments across several gait parameters. They exhibited slower walking speed (WMD = - 0.13, 95% CI [- 0.45, - 0.16], P < 0.001, I(2) = 90.7%), had significantly lower peak dorsiflexion angular velocity (WMD = - 7.93, 95% CI [- 13.45, - 2.41], P = 0.005), and shorter mean step length (WMD = - 0.15, 95% CI [- 0.18, - 0.12], P < 0.001). Single support time was also significantly reduced (WMD = - 16.59, 95% CI [- 19.18, - 14.00], P < 0.001), and cadence was significantly lower (WMD = - 8.44, 95% CI [- 10.87, - 6.01], P < 0.001). Although mean peak plantarflexion angular velocity was lower, this difference was not statistically significant (WMD = - 49.64, 95% CI [- 99.98, 0.71], P = 0.053). Both muscle strength and plantar pressure were notably reduced. CONCLUSIONS: Despite rehabilitation leading to improvements, patients often failed to regain pre-injury levels of walking speed, muscle strength, and normal plantar pressure distribution. Further research is warranted to clarify the pathological mechanisms underlying impaired recovery.