scholarly journals Comparison of Clinical Outcomes after Modified Broström Procedure with or without Calcaneofibular Ligament Repair for Chronic Lateral Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ki Sun Sung ◽  
Hyun Seok Yim
Keyword(s):  
Ankle Instability ◽  
Strength Test ◽  
Isokinetic Strength ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle ◽  
Stress Radiographs ◽  
Lateral Ankle Instability ◽  
Group A ◽  
Group B ◽  
Modified Broström Procedure

Category: Sports Introduction/Purpose: Modified Brostrom procedure has been the choice of treatment for chronic lateral ankle instability(LAI). However, there is a controversy about the necessity for repair of calcaneofibular ligament(CFL). Thus, we designed a prospective randomized control study to investigate if there is any difference according to calcaneofibular repair. Methods: Between June 2012 and September 2015, 48 patients with chronic LAI were enrolled in this study after our IRB(file No. 2012-02-046-035) approved it. They were divided into two groups(24 for each) by a random manner. Inclusion criteria are as following: age of 20 to 60 and chronic mechanical LAI who had failed in conservative treatment for more than 6 months. Patients with inflammatory diseases and history of previous surgery for the same ankle were excluded. Modified Brostrom procedure was done for the patients with informed consent. For group A we repaired both ATFL and CFL, and for group B only ATFL was repaied. Postoperative rehabilitation protocol was the same after 2 week period of immobilization. For clinical and functional outcome, Karlsson-Petersson score was measured pre and post operatively. Stress radiographs were checked to evaluate objective stability. Isokinetic strength test was also recorded. Results: There was no difference in age, gender, BMI, and the number of combined intraarticular pathology between two groups. Forty three patients(22 in group A, 21 in group B) were followed up for more than 1 year after the index surgery. Karlsson score was improved from 55.8(17-80) to 78.4(32-100) in group A, from 56.4(37-82) to 83.6(49-100) without any statiscal difference between 2 groups. Anterior drawer and talar tilt in stress radiographs showed a significant improvement in both groups still without any difference between 2 groups. Similar result was found in isokinetic strength test. Conclusion: There was no clinical, radiographical and physical difference regardless of CFL repair in modified Brostrom procedure for chronic LAI. However, we cannot conclude that CFL repair is not necessary for chronic LAI. Further studies of high level of evidences with more patients and longer term follow-up are mandatory.

scholarly journals Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110040
Author(s):  
Ji Hye Choi ◽  
Kug Jin Choi ◽  
Chin Youb Chung ◽  
Moon Seok Park ◽  
Ki Hyuk Sung ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Tilt Angle ◽  
Ankle Instability ◽  
Interobserver Reliability ◽  
Initial Presentation ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Stress Radiographs ◽  
Lateral Ankle Instability

Background: Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient’s ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated. Purpose: To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC). Results: A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]). Conclusion: Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph.

Talar Anchor Placement for Modified Brostrom Lateral Ankle Stabilization Procedure

2008 ◽  
Vol 98 (6) ◽  
pp. 473-476 ◽  
Author(s):  
Arush K. Angirasa ◽  
Michael J. Barrett
Keyword(s):  
Research Study ◽  
Ankle Instability ◽  
Suture Technique ◽  
Anatomic Reconstruction ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Stabilization Procedure ◽  
Lateral Ankle Ligaments ◽  
Modified Broström Procedure

The modified Brostrom procedure has been a proven procedure with excellent utility in the treatment of lateral ankle instability within limitation. Multiple variations of the original technique have been described in the literature to date. Included in these variations are differences in anchor placement, suture technique, or both. In this research study, we propose placing a bone screw anchor into the lateral shoulder of the talus rather than the typical placement at the lateral malleolus for anatomic reconstruction of the lateral ankle ligaments. (J Am Podiatr Med Assoc 98(6): 473–476, 2008)

scholarly journals Early Outcomes of Arthroscopic Modified Brostrom Operation for Chronic Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Dong-Woo Shim ◽  
Yeokgu Hwang ◽  
Yoo Jung Park ◽  
Jin Woo Lee
Keyword(s):  
Clinical Outcomes ◽  
Gold Standard ◽  
Ankle Instability ◽  
Lateral Ankle ◽  
Vas Score ◽  
Lateral Ankle Instability ◽  
Talar Tilt ◽  
Outcome Evaluations ◽  
Modified Broström Procedure

Category: Ankle, Arthroscopy Introduction/Purpose: The gold standard for the surgical treatment of chronic lateral ankle instability is the modified Brostrom procedure. Surgery aims to re-establish ankle stability and function, without compromising ankle motion. Recently introduced all inside arthroscopic modified Brostrom procedure coincide with the goal on that aspect. The purpose of this study was to investigate the early outcomes of all inside arthroscopic modified Brostrom operation for chronic ankle instability. Methods: From January 2015 to August 2016, 30 patients were included. The visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, Foot and Ankle Outcome Score (FAOS), and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Clinical outcome evaluations were performed preoperatively, at 3 months and 6 months postoperatively, and at a final follow-up using the VAS score, the AOFAS ankle-hindfoot score, FAOS, and Karlsson score. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle. Results: Thirty patients (19 males and 11 females) were followed up for a mean of 11.0 (range 4 – 23) months. The VAS, AOFAS, 1 FAOS subscale (Quality-of-life) and the Karlsson scores were improved significantly at the each follow-up period of 3 month, 6 month and 1 year postoperatively. Other 4 subscales of FAOS showed no significant outcomes (Table 1). The mean anterior talar translation and talar tilt showed significant improvements from 5.8 mm (SD = 0.4) and 7.9° (SD = 1.0) to 5.3 mm (SD = 0.3) and 5.7° (SD = 0.6) at the final follow-up each (p = 0.034, p=0.034). Conclusion: The arthroscopic modified Brostrom technique could be a viable alternative to the gold-standard open modified Brostrom procedure for anatomic repair of chronic lateral ankle instability. It can yield outstanding functional and clinical outcomes without adverse effects in terms of pain.

scholarly journals A Retrospective Chart Review to Examine Failed Modified Brostrom Procedures for Chronic Lateral Ankle Instability

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0040
Author(s):  
Kaitlyn Rizzo ◽  
Greggory Brandle ◽  
Nicholas A. Cheney ◽  
Brian C. Clark
Keyword(s):  
Chart Review ◽  
Ankle Instability ◽  
Retrospective Chart Review ◽  
Tilt Test ◽  
Recurrent Instability ◽  
Lateral Ankle ◽  
Anterior Drawer ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Modified Broström Procedure

Category: Ankle; Other Introduction/Purpose: Recurrent ankle injuries can lead to chronic ankle instability requiring surgical stabilization. Since the anterior talofibular ligament (ATFL) is the weakest of the lateral ankle ligaments, repair is often required in cases of chronic lateral ankle instability. Damage to the calcaneofibular ligament (CFL) is less common than the ATFL, but additional repair of it in these cases may be necessary to avoid this recurrent instability. A modified Brostrom procedure has been a widely accepted surgical approach to chronic lateral ankle instability if conservative measures fail. However, cases of recurrent instability even after initial stabilization surgery can present. The purpose was to examine reasoning for and rate of revision surgeries attempting to fix chronic lateral ankle instability as it relates to the ATFL and CFL integrity. Methods: A retrospective chart review was conducted to assess outcomes of a modified Brostrom procedure to determine underlying reasoning of the need for revision surgery by utilizing results of the anterior drawer and varus tilt tests. The files of these patients were examined via electronic health records to determine the reasoning for surgery. The preoperative and postoperative results of the anterior drawer test (ADT) and varus tilt test were used to examine ATFL and CFL integrity, respectively, in addition to operative notes. Results: 172 patients met criteria having undergone a modified Brostrom dual ligament repair procedure for lateral ankle instability by a single orthopedic foot and ankle surgeon. With a 3.49% revision rate in the patient population, the only similarity found in all of the patients was the presence of a positive varus tilt test indicating the CFL was a major contributor of failed correction via the modified Brostrom procedure. One patient had a positive ADT, and one had a mildly positive ADT. These ADT and varus tests were performed at various time points in the care of the patients. The average length between surgeries was calculated to be 624.2 days. This revision rate is higher than past studies but was limited to a few years under examination. Conclusion: In conclusion, the anterior drawer and varus tilt tests are utilized to determine the integrity of the ATFL and CFL in the lateral ankle ligament complex. In failed modified Brostrom procedures examined, the positive result was consistently in the varus tilt test, indicating that the CFL is the ligament most affected in these patients requiring additional surgery. However, these physical exam tests are only one way to examine the ankle and do not take additional pathologies of the lateral ankle into account. Additional studies are needed to examine long-term outcomes of the modified Brostrom procedure and reasoning for failure.

Knotless all-inside arthroscopic modified Broström procedure for lateral ankle instability

2020 ◽  
Author(s):  
Eui Dong Yeo ◽  
Sung Bum Park ◽  
Sang Woo Lee ◽  
Whi Je Cho ◽  
Hyun Kwon Kim ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Modified Broström Procedure

scholarly journals Obesity as a Risk Factor for Failure following a Modified Brostrom Procedure

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Daniel Corr ◽  
Ryan G. Rogero ◽  
Justin E. Palm ◽  
Joseph N. Daniel ◽  
Steven M. Raikin ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Postoperative Period ◽  
Ankle Instability ◽  
Clinical Success ◽  
Treatment Success ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Modified Broström Procedure

Category: Ankle; Hindfoot Introduction/Purpose: The modified Brostrom procedure has been widely accepted as the operative treatment of choice for treating lateral ankle instability in patients that have failed nonoperative management. However, the predisposing risk factors for failure of operative treatment, which has important implications for patient selection, is unknown. Foot and ankle surgeons often raise body mass index (BMI) as a particular concern due to the increased pressure and strain that is applied to the repair with standing and walking in the setting of an elevated BMI. The purpose of this study was to investigate the effect of patient BMI at the time of surgical intervention on preoperative and long-term postoperative functional outcomes, as well as complication and reoperation rates. Methods: A retrospective single institutional study of 160 modified Brostrom procedures, average age 43.8 years, was performed with a minimum of 2-year follow-up. An electronic query based on Current Procedural Terminology codes was initially performed followed by a manual review of the operative report. Patients with any concurrent osteotomy, arthrodesis, or arthroplasty procedures were excluded. Pre- and postoperative Foot and Ankle Ability Measure (FAAM) ADL and Sports survey responses along with Visual Analog Scale for Pain (0-100) patient reports were recorded. Comorbidities and relevant demographic information were manually obtained. Patients were split into two groups based on their preoperative BMI: those patients with BMI <30 and those >=30 (considered obese). Treatment success was defined as achieving the previously established minimal clinically important difference (MCID) FAAM-ADL increase of >=8 and/or FAAM-Sport increase of >=9 from the preoperative to postoperative period. Results: Of 97 patients with BMI <30, 22 (22.7%) did not demonstrate a self-reported MCID in the FAAM-ADL score, and 20 (20.6%) did not demonstrate positive MCID in the FAAM-Sport score. For the 63 patients with BMI >=30, 13 (20.6%) failed to reach FAAM-ADL MCID, while 12 (19%) failed to reach FAAM-Sport MCID. BMI was not shown to be significant in terms of clinical improvement following surgery, as both groups improved significantly on average from preoperative period to follow-up with 125/160 (78.1%) achieving MCID in FAAM-ADL and 128/160 (80%) achieving MCID in FAAM-Sport. However, patients with BMI <30 had significantly higher average preoperative FAAM-ADL scores than those >=30 (66.7 vs 51.2; p=0.003) and higher average postoperative ADL scores that approached significance (92.9 vs 84.5; p=0.075). Conclusion: The modified Brostrom procedure has been previously shown to effectively improve stability and function of the ankle with relatively high rates of success, and such findings are supported by this study. In addition, this study demonstrates that patient BMI is not a prohibitive factor in limiting clinical success in the postoperative period. The procedure was generally effective for both groups of patients. However, data suggests that the condition of lateral ankle instability may simply be more debilitating for those patients with obese BMI, and that these patients should have lower expectations in terms of their absolute recovery of function. [Table: see text]

Lateral Ankle Instability as a Cause of Superior Peroneal Retinacular Laxity: An Anatomic and Biomechanical Study of Cadaveric Feet

Foot & Ankle ◽  
1993 ◽  
Vol 14 (6) ◽  
pp. 330-334 ◽  
Author(s):  
Mark J. Geppert ◽  
Mark Sobel ◽  
Walther H.O. Bohne
Keyword(s):  
Ankle Instability ◽  
Biomechanical Study ◽  
Peroneal Tendon ◽  
Collateral Ligaments ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle ◽  
Ankle Inversion ◽  
Tendon Reflex ◽  
Lateral Ankle Instability ◽  
Lateral Collateral Ligaments

The role of the competent superior peroneal retinaculum (SPR) as a primary restraint to peroneal tendon subluxation and mechanical attritional wear is clear. Injury to the SPR has classically been described as a dorsiflexion aversion movement of the ankle coupled with a forceful peroneal tendon reflex contraction. This mechanism, however, does not cause injury to the lateral collateral ligaments of the ankle and does not explain the coexistent findings of lateral ankle instability, laxity of the SPR, and concurrent peroneal tendon pathology. Anatomic studies reveal a parallel alignment of the calcaneal band of the SPR and the calcaneofibular ligament. A cadaveric model of ankle instability created by serial sectioning of the lateral collateral ligaments revealed increasing visual strain on the SPR with increasing degrees of ankle instability. These findings suggest the SPR serves as a secondary restraint to ankle inversion stress and that the force or forces that result in chronic ankle instability can also injure and attenuate the superior peroneal retinaculum.

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