Journal List > J Korean Foot Ankle Soc > v.22(3) > 1101927

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

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.

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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.
jkfas-22-83f1.tif
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.
jkfas-22-83f2.tif
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.
jkfas-22-83f3.tif
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.
jkfas-22-83f4.tif
Figure 5.
(A, B) Peroneal tendon strengthening exercise. (C) Proprioception exercise.
jkfas-22-83f5.tif
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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