Clinical Outcomes and Sports Participation After the Modified Broström Procedure in Children and Adolescents With Chronic Lateral Ankle Instability: A 5- to 10-Year Follow-up of 111 Cases

Abstract

Background:

Chronic lateral ankle instability (CLAI) can severely impair sports performance and functional mobility in children and adolescents, necessitating surgical interventions such as the modified Broström procedure. However, midterm to long-term clinical outcomes and sports participation after this procedure remain inconclusive.

Purpose:

To investigate the midterm to long-term clinical outcomes and analyze the reasons and risk factors for failure to participate at preinjury sports levels after the modified Broström procedure in children and adolescents with CLAI.

Study Design:

Case series study; Level of evidence, 4.

Methods:

A total of 144 consecutive patients younger than 18 years with CLAI underwent the modified Broström procedure from August 2014 to July 2019, of whom 126 meeting the inclusion criteria were contacted via telephone to complete a survey. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, Karlsson-Peterson score, Tegner score, and Foot and Ankle Outcome Score (FAOS). A structured questionnaire evaluated the outcomes of sports participation, ankle recurrent sprains, subjective satisfaction, and surgical complications. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing return to preinjury sports levels at final follow-up.

Results:

There were 107 patients (111 ankles; 84.9% follow-up rate) included for analysis, with a mean age at the time of surgery of 15.2 ± 2.0 years and a follow-up period of 5 to 10 years (mean, 86.4 ± 17.7 months). Postoperative clinical scores showed significant improvements compared with preoperative scores, with VAS pain scores decreasing from 4.0 ± 2.1 to 0.8 ± 1.1, the Karlsson-Peterson score increasing from 55.8 ± 20.8 to 91.4 ± 7.9, the Tegner score increasing from 3.6 ± 2.0 to 5.5 ± 1.5, and the total FAOS score increasing from 64.4 ± 18.7 to 93.0 ± 6.2 (P < .001 for all). All cases returned to daily activities and recreational sports levels at a mean time of 5.1 ± 3.6 months after surgery. Among them, 55.0% were able to participate at their preinjury level of sports at final follow-up, while the other 45.0% were not, citing reasons such as ankle-related events (46.0%), health problems (10.0%), life-related events (18.0%), and personal preferences (24.0%). Recurrent sprains occurred in 27.0% of cases, with an overall complication rate of 5.4% (all cases with skin numbness; no infections) and a high patient satisfaction rate of 97.3%. Multivariate analysis identified that being an athlete (P = .035) or having a calcaneofibular ligament injury (P = .040) was negatively related to the success of returning to preinjury sports levels at 5- to 10-year follow-up.

Conclusion:

Over a 5- to 10-year follow-up period, the modified Broström procedure provided satisfactory clinical outcomes in children and adolescents with CLAI, enabling them to resume daily activities and recreational sports. However, approximately one-quarter experienced recurrent sprains, and nearly half of the cohort was not able to achieve their previous sports performance, particularly athletes and those with calcaneofibular ligament injuries.