J Korean Foot Ankle Soc.  2022 Dec;26(4):171-176. 10.14193/jkfas.2022.26.4.171.

Early Unrestricted Weight-Bearing in a Stirrup Brace Following the Broström Procedure with Suture Tape for Chronic Lateral Ankle Instability

• Lee J
• Kwon GH
• Chung JW

• KMID: 2536712
• DOI: http://doi.org/10.14193/jkfas.2022.26.4.171

Abstract

Purpose
This study reports on a series of patients with chronic lateral ankle instability that underwent the Broström procedure with suture tape augmentation and allowed early unrestricted weight-bearing in a simple stirrup brace.
Materials and Methods
This retrospective study was conducted on 36 patients (22 males and 14 females of mean age 34 years [range 23~48 years]) with chronic lateral ankle instability treated using the Broström procedure using suture tape augmentation and inferior extensor retinaculum reinforcement with a fiber-wire connected to a SwiveLock screw inserted into the talus. When possible, patients started unrestricted weight-bearing in a stirrup brace from the third postoperative day. Demographics and functional outcomes, including American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, visual analogue scale (VAS), and satisfaction scores, were recorded. In addition, varus stress radiographs obtained before and 24 months after surgery were compared. Patients were followed for a mean 29 months (range 25~40 months).
Results
Mean AOFAS ankle-hindfoot scores increased from 51 points preoperatively to 92 points at final follow-up, and mean VAS decreased from 6.8 to 1.2 points. Mean patient satisfaction scores were 8.7 at 12 months and 9.6 at 24 months. Stress radiographs demonstrated that talar tilt decreased from a mean 18 degrees preoperatively to 7 degrees at 24 months.
Conclusion
Early unrestricted weight-bearing in a stirrup brace following the Broström procedure with suture tape augmentation is a successful protocol for treating chronic lateral ankle instability.

Keyword

Lateral ankle instability; Ankle ligament repair; Suture tape augmentation; Ankle rehabilitation

Figure

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  Figure 1 Clinical images of the right ankle during surgical procedure (left-proximal, right-distal). (A) After oblique longitudinal incision, the proximal band of the anterior talofibular ligament (ATFL) (arrow) was sharply released. (B) Stem ligament of the inferior extensor retinaculum (IER) (arrow) was checked. (C) At just off the articular cartilage margin, ATFL insertion site on the lateral wall of the talus was drilled first. (D) After passing the suture tape between capsule and sural fascia (dotted arrow), another drilling and tapping were performed about 10 mm from the tip of the fibula. Arrow indicates fiber-wire thread connected to the talar side SwiveLock screw. (E) The stem of IER was sutured using fiber-wire thread connected to the talus.

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  Figure 2 Photographs of a 34-year-old male patient on his 3rd postoperative day. He started unrestricted weight-bearing in a stirrup brace as possible with or without crutches.

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  Figure 3 Clinical image of the second look for a 42-year-old female with persistent tenderness and foreign body sense. The suture tape construct remains inert and integrated into the surrounding native tissue without immunologic severe response (arrow).

Reference

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