Modified Brostrom-Gould surgical procedure for chronic lateral ankle instability compared with other operations: a systematic review and meta-analysis

Arthroscopic modified Broström may improve function while anatomic reconstructions could enhance stability for chronic lateral ankle instability: A network meta-analysis

PURPOSE

The purpose of this systematic review and network meta-analysis was to compare the efficacy of different surgical treatments, including open and arthroscopic modified Broström procedures (MB), anatomical reconstructions, and suture tape augmentations (STA), for chronic lateral ankle instability (CLAI).

METHODS

We conducted a systematic search for comparative studies that included adult patients with CLAI who underwent open MB, arthroscopic MB, reconstruction with autografts or allografts, and STA. We used a random-effects model to present the NMA results, with mean differences and 95 % confidence intervals (CI) for continuous measures and relative ratios with 95 % CI for dichotomous variables. Surface under the cumulative ranking curve analysis (SUCRA) was used for treatment ranking.

RESULTS

The results, based on surface under the cumulative ranking curve analysis, showed that arthroscopic MB likely improves functional outcomes the most as measured by change in American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. Anatomical graft reconstructions with allografts or autografts demonstrated greater reduction in anterior talar translation (ATT) and talar tilt angle (TTA). Arthroscopic MB and STA were associated with fewer complications.

CONCLUSIONS

Arthroscopic MB may be associated with better functional outcomes, while anatomical reconstructions appear to provide greater improvements in stability for CLAI. Additionally, arthroscopic techniques seem to have lower complication risks compared to open procedures. These potential differences in outcomes and risks between techniques could help guide surgical decision-making.

Clinical outcomes of arthroscopic all-inside anterior talofibular ligament suture augmentation repair versus modified suture augmentation repair for chronic ankle instability patients

BACKGROUND

To compare the clinical efficacies of arthroscopic anterior talofibular ligament suture augmentation repair and modified suture augmentation repair in patients with chronic ankle instability (CAI).

METHODS

From October 2019 to August 2020, 100 patients with CAI were enrolled after propensity score matching analysis and observed for two years. Among them, 50 underwent modified suture augmentation repair and the other 50 underwent suture augmentation repair. The clinical efficacies of CAI treatments were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating scale, visual analog scale (VAS), and anterior drawer test scores.

RESULTS

The postoperative AOFAS score of the modified suture augmentation repair group (83.8 ± 11.3) was significantly higher than that of the suture augmentation repair group (76.3 ± 11.3; P = 0.001). The VAS (P = 0.863) and anterior drawer test (P = 0.617) scores were not significantly different between the two treatment groups.

CONCLUSION

Both the modified suture augmentation repair and suture augmentation repair demonstrated good clinical efficacies. The AOFAS score of the modified suture augmentation repair group was superior to that of the conventional suture augmentation repair group. Thus, modified suture augmentation repair is a feasible and practical surgical technique for CAI treatment.

Pure ankle dislocation after modified Broström repair for chronic lateral instability: Case report and literature review

Ankle dislocation with no concomitant malleolar fracture is an overwhelmingly rare injury, and only a relatively limited number of cases have been reported. Diligent management regarding the treatment of these injuries is requisite to attain an auspicious outcome. Lateral ankle instability is a frequent condition that can derive from recurrent sprains, predominantly at a young age. Broström repair, with its modifications and updates, has been established as the optimal solution when treating chronic lateral unsteadiness. We present a peculiar case of a posteromedial ankle dislocation without accompanying fracture in a patient operated on many years before the injury for chronic lateral instability with a modified Broström procedure. No similar case could be retrieved in the existing literature. After the initial clinical and radiological assessment, urgent closed reduction of the dislocation was achieved, and the foot was immobilized. Further imaging was carried out to evaluate the features of the injury. It was deduced that the repairs from the previous operation were intact. The patient was operated on to repair the distal tibiofibular syndesmosis. The postoperative course was uneventful, and absolute functional capacity was eventually accomplished. Demonstrating this rare case, we accentuate the role of implementing the modified Broström procedure in the surgical treatment of chronic lateral ankle instability.

Arthroscopic vs. open Broström-Gould for repairing anterior talofibular ligament: mid-term outcomes comparison

Introduction

There have been few mid-term follow-up studies comparing arthroscopic and open Broström-Gould repair of the anterior talofibular ligament (ATFL). The purpose of this study was to evaluate the mid-term therapeutic effectiveness of arthroscopic ATFL repair with open Broström-Gould repair for chronic lateral ankle instability.

Methods

We retrospectively reviewed the database of patients with chronic lateral ankle instability undergoing repair of the ATFL from June 2014 to June 2018. The choice of surgical approach will depend on computer-generated randomization. In total, 49 patients underwent the arthroscopic Brostrom-Gould technique (group AB), while the other 50 patients underwent the open Broström-Gould technique (group OB). The surgery duration, hospitalization time, postoperative complications, the preoperative/postoperative manual anterior drawer test (ADT), Visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, Karlsson-Peterson (K-P) scores, and Tegner activity scores were collected for comparative analysis during the follow-up period of 48 months.

Results

At the final follow-up, the clinical outcomes, including ADT, VAS, AOFAS, K-P, and Tegner activity scores, were significantly improved after either arthroscopic or open treatment. Specifically, the AOFAS and K-P scores in the group AB were significantly higher than those in the group OB at 6 months post-surgery (P < 0.05). Additionally, there were no significant differences in other clinical outcomes and postoperative complications between the two groups.

Conclusions

Arthroscopic has predictable and good mid-term results after ATFL and may be a secure and effective alternative to open Broström-Gould repair.