All-inside arthroscopic modified Broström-Gould procedure for chronic lateral ankle instability with and without anterior talofibular ligament remnant repair produced similar functional results

Abstract

Purpose The Broström-Gould procedure, with the repair of the anterior talofibular ligament (ATFL) combined with the transfer of the extensor retinaculum, is considered the gold standard procedure for the management of chronic lateral ankle instability (CLAI). Lateral ligament reconstruction is considered if the ATFL remnant quality is poor or the ATFL has been damaged beyond the ability to suture it. It remains unclear whether not repairing the ATFL remnant produces comparable functional outcomes to the classical Broström-Gould procedure. Methods This retrospective cohort study included 84 patients with CLAI undergoing either repair or non-repair of the ATFL remnant using an all-inside arthroscopic Broström-Gould procedure from 2015 to 2018. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. Results All the functional scores (VAS, AOFAS, KAFS, ATT, AJPS) significantly improved in both groups at 1 and 2 years after surgery. At all the follow-up time points, the VAS, AOFAS, KAFS, ATT, AJPS, and the rate of return to sport scores were comparable between the repair and non-repair group. Conclusion There are no statistically significant differences in postoperative outcomes between ATFL remnant repair and non-repair for the management of CLAI using the all-inside arthroscopic Broström-Gould procedure. From the clinical viewpoint, the present study shows that the potential differences in clinical outcomes between ATFL remnant repair and non-repair are likely not relevant when performing an all-inside arthroscopic Broström-Gould procedure for CLAI. Level of evidence III.

The ALR-RSI score is a valid and reproducible scale to assess psychological readiness before returning to sport after modified Broström-Gould procedure

“…Similar outcomes were observed by Nery et al [ 21 ] following MBG procedure at an average follow-up of 10-year follow-up. More recently, Feng et al [ 6 ] compared outcomes between arthroscopic MBG procedure with and without repair of the ATFL remnant. No difference was found in terms of ankle function or RTS rate between the repair and non-repair group at a minimum 2-year follow-up.…”

“…The modified Broström-Gould procedure (MBG) remains the gold standard for the management of CLAI and consists in the association of the ATFL repair (retention and direct suture) and the transfer of the extensor retinaculum [ 6 , 16 , 29 ]. The all-arthroscopic approach is increasingly used, to assess and address any associated intra-articular lesions with reduced morbidity for the patient [ 19 , 21 , 37 ].…”

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair

“…The arthroscopic modified Broström procedure, with anterior talofibular ligament and inferior extensor retinaculum suture, is an established treatment of CLAI [ 16 , 18 – 20 ]. Arthroscopic joint debridement and microfracture are indicated for the management of limited (no more than 15 mm in diameter and 8 mm in depth) OLTs [ 21 , 22 ].…”

“…A double-loaded suture anchor (Fastin RC 3.5 mm, Smith & Nephew, Andover, MA) was inserted into the distal fibula at the mid-portion of the footprint region. The anterior talofibular ligament and the inferior extensor retinaculum were sutured as previously described [ 16 ]. With the operated ankle placed at 5° of eversion, the suture knot was tightened with a knot pusher.…”

Ankle Arthroscopy Procedural Volume Is Low Among Graduating Orthopaedic Surgery Residents

“… 14 For example, the combined use of ankle arthroscopy and peroneal tendon retinacular repair has increased by 50% from 2007 to 2011. 14 In addition, surgeons are now using arthroscopic techniques to perform all-inside ankle ligament reconstruction, 37 , 38 , 39 , 40 , 41 , 42 , 43 arthroscopic-assisted ankle fracture fixation, 17 , 44 and arthrodesis, 18 , 19 with favorable results.…”