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Abstract
Purpose
This study was performed prospectively and randomly to compare the clinical outcomes of modified-Brostrom procedures using the suture anchor and the bone tunnel for chronic lateral ankle instability.
Materials and Methods
Thirty patients were followed up for more than 1 year after the modified-Brostrom procedures. Fifteen procedures treated with a suture anchor and 15 procedures treated with a bone tunnel technique assigned randomly were performed by a single surgeon. The clinical evaluation was performed according to the VAS for pain, the Karlsson scale and Sefton grading system. Measurements of the talar tilt and anterior talar translation was performed using anterior and varus stress radiographs.
Results
There were no significant differences in the pain VAS between the 2 techniques postoperatively. However, the pain VAS at postoperative 4th day was significantly higher in the bone tunnel group. The Karlsson scale had improved significantly from a preoperative average of 45.2 points to 90.1 points in the suture anchor group, and from 44.6 points to 88.3 points in the bone tunnel group. According to the Sefton grading system, 13 cases (86.7%) in the suture anchor group and 12 cases (80%) in the bone tunnel group achieved satisfactory results. The talar tilt angle and anterior talar translation had improved significantly from preoperative average of 14.2° and 6.2 mm to 6.4° and 4.5 mm in the suture anchor group, from 13.8° and 6.4 mm to 6.1° and 4.2 mm in the bone tunnel group. There were no significant differences between 2 techniques.
Conclusion
The techniques for ligament reattachment produced similar clinical and functional outcomes except for early-stage postoperative pain. Both modified-Brostrom procedures using the suture anchor and bone tunnel appear to be effective treatment methods for chronic lateral ankle instability. However, the suture anchor technique has an advantage of less early-stage postoperative pain.
Figures and Tables
Figure 1
(A-B) Operative Photographs show reattachment of anterior talofibular and calcaneofibular ligaments using bone tunnel, and plication by periosteocapsular flap.
Figure 2
(A) Operative Photograph showing application of suture anchor into anatomic origin of anterior talofibular ligament. (B-C) The periosteocapsular flap created on the fibula is plicated over secured capsule(arrowhead) with the suture anchor. (D) The inferior extensor retinaculum was advanced and reattached to the periosteal flap.
Figure 4
This graph shows progression and improvement of postoperative ankle pain. Significant differences in pain VAS were not found between 2 techniques except for postoperative 4th day.
Table 1
Comparison between Bone Tunnel Group and Suture Anchor Group with Karlsson Scale (Mann-Whitney Test)
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