J Korean Foot Ankle Soc.  2022 Mar;26(1):40-47. 10.14193/jkfas.2022.26.1.40.

Comparison of the Modified Bröstrom Repair Technique with and without Augmentation Using Suture Tape for Chronic Ankle Instability

• Gwak HC
• Jung SH
• Kim JH
• Park DH
• Choo HJ
• Kim DY

• KMID: 2527011
• DOI: http://doi.org/10.14193/jkfas.2022.26.1.40

Abstract

Purpose
The modified Broström repair (BR) technique has yielded good outcomes in patients with chronic ankle instability. This study compared clinical and radiological outcomes between two groups of patients who underwent modified BR or lateral ligament augmentation using suture tapes (ST).
Materials and Methods
Seventy-seven patients (ST group [n=47], BR group [n=30]; body mass index <26.61 kg/m² ; mean age, 30.7±11.0 years [range, 17~39 years]; mean follow-up, 34.0±12.0 months [range, 24~59 months]) were retrospectively reviewed between January 2014 and July 2017. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS) score, and Sefton grading system were used for clinical assessment. The talar tilt angle and anterior talar translation were measured using the Telos stress device (Telos GmbH, Marburg, Germany) at 150 N for radiological evaluation.
Results
FAOS, AOFAS, FAAM, and VAS scores improved in both groups at final follow-up (ST, 91.1±5.2, 93±2, 88.1±4.5, 1.5±0.7 vs. BR, 91.3±5.4, 93±3, 83.3±4.8, 1.2±0.7, respectively; p=0.854, 0.971, <0.001, 0.04, respectively). According to the FAOS, mean sports activity scores for the ST and BR groups at the final follow-up were 90.3±3.2 and 76.6±4.2, respectively, reflecting superior outcomes in the ST group (p<0.001). Sefton grading revealed satisfactory functional outcomes (ST, 91.5% vs. BR, 90.0%) . There was significant improvement in the talar tilt angle and anterior talar translation in both the ST and BR groups (7.6°±1.2°, 10.5±1.8 mm vs. 4.9°±1.1°, 7.9±1.5 mm, respectively; p<0.001).
Conclusion
The ST group demonstrated comparable clinical but better improvement in mechanical stability and FAOS sports scores than the BR group.

Keyword

Chronic ankle instability; Ligament augmentation; Suture tape

Figure

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  Figure. 1 Patients flow chart.

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  Figure. 2 Intraoperative photographs. (A) The first drill hole is made at the footprint of the anterior talofibular ligament (ATFL) on the talus. The talus is drilled at 45° to the sagittal plane with the foot in a neutral position. (B) The second drill hole is drilled at the footprint of the ATFL on the fibula.

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  Figure. 3 Accurate suture anchor position and ankle stability are confirmed using (A) anteroposterior and (B) lateral view of plain radiograph.

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  Figure. 4 Mechanical stability was evaluated using the varus stress test (A) and anterior drawer test (B), measured using the Telos device (Telos GmbH, Marburg, Germany) at 150 N.

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  Figure. 5 Stress radiograph of a 33-year-old male patient. Radiograph showing the preoperative finding of (A) talar tilt angle and (B) anterior talar translation 11.4°, 12.52 mm respectively. (B) Radiograph showing the postoperative finding of (C) talar tilt angle and (D) anterior talar translation 3.4°, 4.93 mm respectively.

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