Abstract
Background
Various surgical techniques are available to reduce chronic instability of the lateral ankle ligament complex. The most effective method for these procedures remains controversial. This report presents a surgical technique that is similar to the Broström procedure and uses a modified, nonaugmented repair technique.
Materials and Methods
38 soldiers with a history of chronic lateral ankle instability and poor ankle function underwent plication of the anterior talofibular ligament-lateral capsule complex with transosseous fixation of the calcaneofibular ligament through a fibular bone tunnel between 2004 and 2007. This study included 33 men and 5 women with a mean age of 25.6 years (range 18–36 years) at the time of surgery. Each patient was confirmed to have a history of chronic lateral ankle instability after an inversion injury, and symptoms had been noted for at least 1 year. The patients were followed up with stress radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, and the Sefton assessment system. The mean followup period was 77.6 months (range 66-89 months).
Results
At the last evaluation, the talar tilt reduced from an average of 13.9° ± 2.4° before surgery to 3.8° ± 1.8° after surgery, and anterior drawer displacement reduced from 9.6 ± 2.9 mm to 2.3 ±1.6 mm. The mean AOFAS ankle-hindfoot scale score for functional stability increased from 71.6 ± 4.0 points preoperatively to 95.6 ± 4.0 points postoperatively. As evaluated by the Sefton assessment system, 36 patients (95%) reported an excellent or good functional outcome. All patients resumed normal daily activities and active military duty after the surgery.
Conclusion
The procedure described here could be considered a viable alternative option to anatomic reconstruction such as the modified Broström procedure and might be appropriate for the general population.
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References
Hershkovich O, Tenenbaum S, Gordon B, Bruck N, Thein R, Derazne E, et al. A large-scale study on epidemiology and risk factors for chronic ankle instability in young adults. J Foot Ankle Surg 2015;54:183–7.
Lohrer H, Nauck T. Augmented periosteal flap repair of the chronically unstable calcaneocuboid joint. A series of six cases. J Bone Joint Surg Am 2006;88:1596–601.
Colville MR, Marder RA, Boyle JJ, Zarins B. Strain measurement in lateral ankle ligaments. Am J Sports Med 1990;18:196–200.
Yamamoto H, Yagishita K, Ogiuchi T, Sakai H, Shinomiya K, Muneta T. Subtalar instability following lateral ligament injuries of the ankle. Injury 1998;29:265–8.
Ozeki S, Yasuda K, Kaneda K, Yamakoshi K, Yamanoi T. Simultaneous strain measurement with determination of a zero strain reference for the medial and lateral ligaments of the ankle. Foot Ankle Int 2002;23:825–32.
Gerstner Garces JB. Chronic ankle instability. Foot Ankle Clin 2012;17:389–98.
Takao M, Ochi M, Uchio Y, Naito K, Kono T, Oae K. Osteochondral lesions of the talar dome associated with trauma. Arthroscopy 2003;19:1061–7.
Sugimoto K, Takakura Y, Okahashi K, Samoto N, Kawate K, Iwai M. Chondral injuries of the ankle with recurrent lateral instability: An arthroscopic study. J Bone Joint Surg Am 2009;91:99–106.
Lee J, Hamilton G, Ford L. Associated intraarticular ankle pathologies in patients with chronic lateral ankle instability: Arthroscopic findings at the time of lateral ankle reconstruction. Foot Ankle Spec 2011;4:284–9.
Broström L. Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir Scand 1966;132:551–65.
Krantz N, Giraud F, Miletic B, Girard J, Berton C, Duquennoy A, et al. Long term outcome of Duquennoy lateral ligament repair for chronic ankle instability: Repeated evaluated in the SME series at 3 and 25 years followup. J Bone Joint Surg Br 2011;93:538.
Gould N, Seligson D, Gassman J. Early and late repair of lateral ligament of the ankle. Foot Ankle 1980;1:84–9.
Cottom JM, Rigby RB. The “all inside” arthroscopic Broström procedure: A prospective study of 40 consecutive patients. J Foot Ankle Surg 2013;52:568–74.
Corte-Real NM, Moreira RM. Arthroscopic repair of chronic lateral ankle instability. Foot Ankle Int 2009;30:213–7.
Li X, Killie H, Guerrero P, Busconi BD. Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: Functional outcomes after the modified Broström repair using suture anchors. Am J Sports Med 2009;37:488–94.
Keller M, Grossman J, Caron M, Mendicino RW. Lateral ankle instability and the Brostrom-Gould procedure. J Foot Ankle Surg 1996;35:513–20.
Ng ZD, Das De S. Modified Brostrom-Evans-Gould technique for recurrent lateral ankle ligament instability. J Orthop Surg (Hong Kong) 2007;15:306–10.
Baumhauer JF, O’Brien T. Surgical considerations in the treatment of ankle instability. J Athl Train 2002;37:458–62.
Karlsson J, Bergsten T, Lansinger O, Peterson L. Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am 1988;70:581–8.
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349–53.
Sefton GK, George J, Fitton JM, McMullen H. Reconstruction of the anterior talofibular ligament for the treatment of the unstable ankle. J Bone Joint Surg Br 1979;61-B:352–4.
Rosenbaum D, Becker HP, Wilke HJ, Claes LE. Tenodeses destroy the kinematic coupling of the ankle joint complex. A three-dimensional in vitro analysis of joint movement. J Bone Joint Surg Br 1998;80:162–8.
Krips R, van Dijk CN, Halasi PT, Lehtonen H, Corradini C, Moyen B, et al. Long term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: A multicenter study. Foot Ankle Int 2001;22:415–21.
Hamilton WG, Thompson FM, Snow SW. The modified Brostrom procedure for lateral ankle instability. Foot Ankle 1993;14:1–7.
Liu SH, Jacobson KE. A new operation for chronic lateral ankle instability. J Bone Joint Surg Br 1995;77:55–9.
Messer TM, Cummins CA, Ahn J, Kelikian AS. Outcome of the modifed Broström procedure for chronic lateral ankle instability using suture anchors. Foot Ankle Int 2000;21:996–1003.
Jeys LM, Harris NJ. Ankle stabilization with hamstring autograft: A new technique using interference screws. Foot Ankle Int 2003;24:677–9.
Louden KW, Ambrose CG, Beaty SG, McGarvey WC, Clanton TO. Tendon transfer fixation in the foot and ankle: A biomechanical study evaluating two sizes of pilot holes for bioabsorbable screws. Foot Ankle Int 2003;24:67–72.
Rupp S, Georg T, Gauss C, Kohn D, Seil R. Fatigue testing of suture anchors. Am J Sports Med 2002;30:239–47.
Giza E, Nathe R, Nathe T, Anderson M, Campanelli V. Strength of bone tunnel versus suture anchor and push-lock construct in Broström repair. Am J Sports Med 2012;40:1419–23.
Li HY, Hua YH, Wu ZY, Chen B, Chen SY Strength of suture anchor versus transosseous tunnel in anatomic reconstruction of the ankle lateral ligaments: A biomechanical study. Arthroscopy 2013;29:1817–25.
Ahmad CS, Stewart AM, Izquierdo R, Bigliani LU. Tendon-bone interface motion in transosseous suture and suture anchor rotator cuff repair techniques. Am J Sports Med 2005;33:1667–71.
Singhatat W, Lawhorn KW, Howell SM, Hull ML. How four weeks of implantation affect the strength and stiffness of a tendon graft in a bone tunnel: A study of two fixation devices in an extraarticular model in ovine. Am J Sports Med 2002;30:506–13.
Girard P, Anderson RB, Davis WH, Isear JA, Kiebzak GM. Clinical evaluation of the modified Brostrom-Evans procedure to restore ankle stability. Foot Ankle Int 1999;20:246–52.
Lohrer H, Nauck T, Arentz S, Schöll J. Observer reliability in ankle and calcaneocuboid stress radiography. Am J Sports Med 2008;36:1143–9.
Beynnon BD, Webb G, Huber BM, Pappas CN, Renström P, Haugh LD. Radiographic measurement of anterior talar translation in the ankle: Determination of the most reliable method. Clin Biomech (Bristol, Avon) 2005;20:301–6.
DIGiovanni BF, Fraga CJ, Cohen BE, Shereff MJ. Associated injuries found in chronic lateral ankle instability. Foot Ankle Int 2000;21:809–15.
Strauss JE, Forsberg JA, Lippert FG 3rd. Chronic lateral ankle instability and associated conditions: A rationale for treatment. Foot Ankle Int 2007;28:1041–4.
Hennrikus WL, Mapes RC, Lyons PM, Lapoint JM. Outcomes of the Chrisman-Snook and modified-Broström procedures for chronic lateral ankle instability. A prospective, randomized comparison. Am J Sports Med 1996;24:400–4.
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Weng, PW., Chen, CY., Tsuang, YH. et al. A Modified Broström Repair with Transosseous Fixation for Chronic Ankle Instability: A Midterm Followup Study in Soldiers. IJOO 52, 315–321 (2018). https://doi.org/10.4103/ortho.IJOrtho_265_16
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DOI: https://doi.org/10.4103/ortho.IJOrtho_265_16