A Modified Broström Repair with Transosseous Fixation for Chronic Ankle Instability: A Midterm Followup Study in Soldiers

Pei-Wei Weng; Chih-Yu Chen; Yang-Hwei Tsuang; Jui-Sheng Sun; Chian-Her Lee; Cheng-Kung Cheng

doi:10.4103/ortho.IJOrtho_265_16

A Modified Broström Repair with Transosseous Fixation for Chronic Ankle Instability: A Midterm Followup Study in Soldiers

Indian J Orthop. 2018 May-Jun;52(3):315-321. doi: 10.4103/ortho.IJOrtho_265_16.

Authors

Pei-Wei Weng^{1

2

3}, Chih-Yu Chen^{1

2

3}, Yang-Hwei Tsuang^{2

3}, Jui-Sheng Sun⁴, Chian-Her Lee², Cheng-Kung Cheng¹

Affiliations

¹ Department of Biomedical Engineering, National Yang-Ming University, Taiwan.
² Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.
³ Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, Taiwan.
⁴ Department of Orthopedic Surgery, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.

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.

Keywords: Ankle injuries; Chronic lateral ankle instability; ankle lateral ligaments; calcaneofibular ligament; chronic ankle instability; modified Broström procedure; nonaugmented repair.