Bi O Jeong; Yeok Gu Hwang

doi:10.14193/jkfas.2018.22.3.83

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Jeong and Hwang: Ligament Repair in Chronic Lateral Ankle Instability: Efficacy and Technique of Broström Procedures

Review Article

J Korean Foot Ankle Soc 2018;22(3):83-90.

Published online: 20 January 2018

DOI: https://doi.org/10.14193/jkfas.2018.22.3.83

Ligament Repair in Chronic Lateral Ankle Instability: Efficacy and Technique of Broström Procedures

Bi O Jeong, Yeok Gu Hwang

Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea

Corresponding Author: Yeok Gu Hwang Department of Orthopedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea Tel: 82-2-958-8346, Fax: 82-2-964-3865, E-mail: seannyhwang@hotmail.com ORCID: https://orcid.org/0000-0001-9889-6172

Received 16 July 2018 Revised 28 August 2018 Accepted 28 August 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Chronic lateral ankle instability occurs in 10% to 20% of individuals after acute ankle sprain. The management of chronic lateral ankle instability is traditionally conservative treatment in the acute phase. On the other hand, surgical intervention is considered if conservative treatment fails and the symptoms are ongoing. This review focuses on the surgical approaches to treatment of chronic lateral ankle instability, including Broström surgical techniques, with a review of the traditional procedure and newer techniques.

Keywords: Ankle, Chronic lateral ankle instability, Modified Broström procedure

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Figure 1.

(A) Varus stress test and anterior draw test; It can be seen that there is a widening of the joint space on the basis of the varus stress test. (B) In the anterior draw test, the talus was displaced anteriorly.

Figure 2.

(A) Broström procedure (1966). (B) Gould modification procedure (1980). Revised from the article of Chung (J Korean Orthop Assoc. 2014;49:13–21)²⁴⁾ in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 3.0) license.

Figure 3.

Karlsson procedure (1988). Revised from the article of Chung (J Korean Orthop Assoc. 2014;49:13–21)²⁴⁾ in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 3.0) license.

Figure 4.

(A) Complete tear of anterolateral capsule and anterior talofibular and calcaneofibular ligament. (B, C) Repair of anterior talofibular ligament with suture anchor. (D) Completion of surgical repair.

Figure 5.

(A, B) Peroneal tendon strengthening exercise. (C) Proprioception exercise.

Table 1.

Results of Broström and Broström-Gould Procedures

Study	Country	Patient (n)	Ankle (n)	Mean age (yr)	Mean F/U	Good/excellent (%)	Complication	Note
Messer et al.^{29) (2000)}	USA	22	22	27.2	34.5 mo	91.0	1 superficial wound infection 1 diminished sensation in the superficial peroneal nerve distribution	Generalized ligamentous laxity; none of these patients had an excellent result, and they had lower “overall satisfaction” scores
Brodsky et al.⁹⁾ (2005)	USA	73	73	31.0	64 mo	98.6	None reported	None reported
Bell et al.³⁷⁾ (2006)	USA	22	23	20.7	26.3 yr	90. 9	None reported	United States Naval Academy cohort, longest F/U in literature for Broström
Buerer et al.³⁵⁾ (2013)	Switzerland	41	41	33.7	Min. F/U 1 yr (range, 13∼ 72 mo)	92.7	3 dissatisfied patients: 1 having ankle numbness, 2 with persistent pain, 3 with persistent instability	Normal motion in 93%
Cho et al.³⁶⁾ (2013)	Korea	50	50	32.2	30 mo	90	1 superficial wound infection, 1 superficial peroneal nerve injury, 1 postoperative ganglion cyst	No significant difference between single- and double-row suture anchor repairs
Choi et al.³⁸⁾ (2008)	Korea	64	65	27	28.7 mo	Unclear	3 with persistent instability, 6 with pain during activity, 5 with slight decrease in ROM	Classified patients by number of Intra-articular lesions; found that syndesmosis widening, osteochondral lesion of talus of talus and ossicles predicted poorer results
Ferkel and Chams¹⁴⁾ (2007)	USA	21	21	28	60 mo	100	None reported	20/21 with intra-articular pathology
Hua et al.³⁹⁾ (2010)	China	79	79	24.4	29 mo	92.5	2 superficial wound infections, 2 transient superficial peroneal neuritis, 1 chronic regional pain syndrome	90.8% with associated intra-articular pathology
Lee et al.⁴⁰⁾ (2011)	Korea	30	30	23	10.6 yr	93.3	None reported	Only repaired ATFL plus imbrication of IER
Li et al.⁴¹⁾ (2009)	USA	52	52	19.6	29 mo	Unclear	3 superficial wound infections, 3 traumatic reruptures, 3 patients with decreased ROM	Study population of high demand athletes
Nery et al.⁴²⁾ (2011)	Brazil/UK	38	38	28.8	9.8 yr	94.7	None reported	Arthroscopically assisted technique
Maffulli et al.²⁰⁾ (2013)	UK	38	38	None reported	8.7 yr	79.0		22 patients (58%) practiced sport at the preinjury level, 6 patients (16%) had changed to lower levels but were still active in less demanding sports (cycling and tennis), and 10 patients (26%) had abandoned active sport participation.

F/U: follow-up, Min.: minimum, ROM: range of motion, ATFL: anterior talofibular ligament, IER: inferior extensor retinaculum.

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