Comparison of Bone Tunnel and Suture Anchor Techniques in the Modified Broström Procedure for Chronic Lateral Ankle Instability

Abstract

Background:

The modified Broström procedure is frequently used to treat chronic lateral ankle instability. There are 2 common methods of the modified Broström procedure, which are the bone tunnel and suture anchor techniques.

Purpose:

To compare the clinical outcomes of the modified Broström procedure using the bone tunnel and suture anchor techniques.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Eighty-one patients (81 ankles) treated with the modified Broström procedure for chronic lateral ankle instability constituted the study cohort. The 81 ankles were divided into 2 groups, namely, a bone tunnel technique (BT group; 40 ankles) and a suture anchor technique (SA group; 41 ankles). The Karlsson score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, anterior talar translation, and talar tilt angle were used to evaluate clinical and radiographic outcomes. The BT group consisted of 32 men and 8 women with a mean age of 34.8 years at surgery and a mean follow-up duration of 34.2 months. The SA group consisted of 33 men and 8 women with a mean age of 33.3 years at surgery and a mean follow-up duration of 32.8 months.

Results:

Mean Karlsson scores improved significantly from 57.0 points preoperatively to 94.9 points at final follow-up in the BT group and from 59.9 points preoperatively to 96.4 points at final follow-up in the SA group. Mean AOFAS scores also improved from 64.2 points preoperatively to 97.8 points at final follow-up in the BT group and from 70.3 points preoperatively to 97.4 points at final follow-up in the SA group. Mean anterior talar translations in the BT group and SA group improved from 9.0 mm and 9.2 mm preoperatively to 6.5 mm and 6.8 mm at final follow-up, respectively. Mean talar tilt angles were 12.0° in the BT group and 12.5° in the SA group preoperatively and 8.8° at final follow-up for both groups. No significant differences were found between the 2 groups in terms of the Karlsson score, AOFAS score, anterior talar translation, and talar tilt angle.

Conclusion:

The bone tunnel and suture anchor techniques of the modified Broström procedure showed similar good functional and radiographic outcomes. Both techniques appear to be effective and reliable methods for the treatment of chronic lateral ankle instability.

Keywords

ankle chronic lateral instability modified Broström procedure bone tunnel technique suture anchor technique

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References

Ahlgren

Larsson

. Reconstruction for lateral ligament injuries of the ankle. J Bone Joint Surg Br. 1989;71:300-303.

Balduini

Vegso

Torg

. Management and rehabilitation of ligamentous injuries to the ankle. Sports Med. 1987;4:364-380.

Barker

Beynnon

Renström

. Ankle injury risk factors in sports. Sports Med. 1997;23:69-74.

Baumhauer

O’Brien

. Surgical considerations in the treatment of ankle instability. J Athl Train. 2002;37:458-462.

Cho

Kim

Choi

Shon

Park

. Comparison between suture anchor and transosseous suture for the modified-Broström procedure. Foot Ankle Int. 2012;33:462-468.

Choi

Lee

Han

Kim

Lee

. Chronic lateral ankle instability: the effect of intra-articular lesions on clinical outcome. Am J Sports Med. 2008;36:2167-2172.

Colville

. Surgical treatment of the unstable ankle. J Am Acad Orthop Surg. 1998;6:368-377.

DiGiovanni

Partal

Baumhauer

. Acute ankle injury and chronic lateral instability in the athlete. Clin Sports Med. 2004;23:1-19.

Ferkel

Chams

. Chronic lateral instability: arthroscopic findings and long-term results. Foot Ankle Int. 2007;28:24-31.

10.

Ferran

Maffulli

. Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin. 2006;11:659-662.

11.

Fong

Hong

Chan

Yung

Chan

. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37:73-94.

12.

Fujii

Kitaoka

Watanabe

Luo

. Comparison of modified Broström and Evans procedures in simulated lateral ankle injury. Med Sci Sports Exerc. 2006;38:1025-1031.

13.

Gould

Seligson

Gassman

. Early and late repair of lateral ligament of the ankle. Foot Ankle. 1980;1:84-89.

14.

Hess

Caborn

Rehak

Harner

. Surgical treatment of chronic lateral ankle instability using the Mitek suture anchor system. Pittsburgh Orthop J. 1991;2:54-59.

15.

Hølmer

Søndergaard

Konradsen

Nielsen

Jørgensen

. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int. 1994;15:72-74.

16.

Karlsson

Bergsten

Lansinger

Peterson

. Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am. 1988;70:581-588.

17.

Karlsson

Eriksson

Bergsten

Rudholm

Swärd

. Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint. Am J Sports Med. 1997;25:48-53.

18.

Karlsson

Peterson

. Evaluation of ankle joint function: the use of a scoring scale. Foot. 1991;1:15-19.

19.

Kitaoka

Alexander

Adelaar

Nunley

Myerson

Sanders

. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349-353.

20.

Konradsen

Bech

Ehrenbjerg

Nickelsen

. Seven years follow-up after ankle inversion trauma. Scand J Med Sci Sports. 2002;12:129-135.

21.

Krips

Brandsson

Swensson

van Dijk

Karlsson

. Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle: clinical and radiological findings after follow-up for 15 to 30 years. J Bone Joint Surg Br. 2002;84:232-236.

22.

Krips

van Dijk

Lehtonen

Halasi

Moyen

Karlsson

. Sports activity level after surgical treatment for chronic anterolateral ankle instability: a multicenter study. Am J Sports Med. 2002;30:13-19.

23.

Killie

Guerrero

Busconi

. 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;37:488-494.

24.

Messer

Cummins

Ahn

Kelikian

. Outcome of the modified Broström procedure for chronic lateral ankle instability using suture anchors. Foot Ankle Int. 2000;21:996-1003.

25.

Okuda

Kinoshita

Morikawa

Yasuda

Abe

. Arthroscopic findings in chronic lateral ankle instability: do focal chondral lesions influence the results of ligament reconstruction? Am J Sports Med. 2005;33:35-42.

26.

Paden

Stone

McGarry

. Modified Brostrom lateral ankle stabilization utilizing an implantable anchoring system. J Foot Ankle Surg. 1994;33:617-622.

27.

Riegler

. Reconstruction for lateral instability of the ankle. J Bone Joint Surg Am. 1984;66:336-339.

28.

Schmidt

Benesch

Friemert

Herbst

Claes

Gerngross

. Anatomical repair of lateral ligaments in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc. 2005;13:231-237.

29.

Snook

Chrisman

Wilson

. Long-term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle. J Bone Joint Surg Am. 1985;67:1-7.

30.

Sugimoto

Takakura

Akiyama

Kamei

Kitada

Kumai

. Long-term results of Watson-Jones tenodesis of the ankle: clinical and radiographic findings after ten to eighteen years of follow-up. J Bone Joint Surg Am. 1998;80:1587-1596.

31.

Vainionpää

Kirves

Läike

. Lateral instability of the ankle and results when treated by the Evans procedure. Am J Sports Med. 1980;8:437-439.

32.

van der Rijt

Evans

. The long-term results of Watson-Jones tenodesis. J Bone Joint Surg Br. 1984;66:371-375.

33.

Yeung

Chan

Yuan

. An epidemiological survey on ankle sprain. Br J Sports Med. 1994;28:112-116.

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