J Korean Foot Ankle Soc.  2014 Sep;18(3):108-114. 10.14193/jkfas.2014.18.3.108.

Functional Evaluation after Modified Brostrom Procedure with Suture Bridge Technique for Chronic Ankle Instability in Athletes

• Park JK
• Park KJ
• Cho BK
• Im CW

• KMID: 2333474
• DOI: http://doi.org/10.14193/jkfas.2014.18.3.108

Abstract

PURPOSE
Ligament reattachment technique using a suture anchor appears to show satisfactory functional outcomes and mechanical stability compared with conventional bone tunnel technique. This study was prospectively conducted in order to evaluate functional outcomes of modified Brostrom procedures using the suture bridge technique for chronic ankle instability in athletes.
MATERIALS AND METHODS
Twenty eight athletes under 30 years of age were followed for more than two years after undergoing the modified Brostrom procedure using the suture bridge technique. Functional evaluation consisted of the foot and ankle outcome score (FAOS), foot and ankle ability measure (FAAM) score. Range of motion and time to return to exercise were evaluated using a periodic questionnaire. Talar tilt angle and anterior talar translation were measured through stress radiographs for evaluation of mechanical stability.
RESULTS
FAOS improved significantly from preoperative mean 59.4 points to 91.4 points (p<0.001). Daily living and sport activity scores of FAAM improved significantly from preoperative mean 50.5, 32.5 points to 94.8, 87.3 points, respectively (p<0.001). Talar tilt angle and anterior talar translation improved significantly from preoperative mean 16.8degrees, 13.5 mm to 4.2degrees, 4.1 mm at final follow-up (p<0.001). Times to return to exercise were as follows: mean 10.2 weeks in jogging, 15.4 weeks in spurt running, 13.1 weeks in jumping, 11.5 weeks in walking on uneven ground, 9.1 weeks in standing on one leg, 7.2 weeks in tip-toeing gait, 8.4 weeks in squatting, and 10.6 weeks in descending stairs.
CONCLUSION
Modified Brostrom procedure using the suture bridge technique showed satisfactory functional outcomes for chronic ankle instability in athletes. Optimal indication and cost-effectiveness of the suture bridge technique will be studied in the future.

Keyword

Ankle; Instability; Athletes; Brostrom; Suture bridge

MeSH Terms

Ankle*
Athletes*
Follow-Up Studies
Foot
Gait
Humans
Jogging
Leg
Ligaments
Prospective Studies
Range of Motion, Articular
Running
Sports
Suture Anchors
Sutures*
Walking
Surveys and Questionnaires

Figure

• 

  Figure 1. (A) Schematic drawing of the suture bridge technique describes the attachment of lateral ankle ligaments with two suture anchors. (B) Schematic drawing of the suture bridge technique describes the reinforcement using two knotless anchors.

• 

  Figure 2. (A) Intraoperative photograph shows additional compression at ligament reattachment site with knotless anchors. (B) Intraoperative photograph shows the repair configuration after modified Brostrom procedure using the suture bridge technique.

• 

  Figure 3. (A) Postoperative stress radiograph shows the varus stability of ankle and the placement of suture anchors in fibula (white arrows: position of two knotless anchors). (B) Postoperative stress radiograph shows a stable anterior talar translation and the placement of suture anchors in fibula (black dots: position of two knotless anchors). AP: anteroposterior, LAT: lateral.

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