Association of Radiographic Alignment, Degree of Ankle Instability, Concomitant Pathology, and VAS Pain Scores after the Brostrom-Gould Procedure for Chronic Ankle Instability

Abstract

Category: Sports; Ankle; Arthroscopy Introduction/Purpose: The Brostrom-Gould procedure is the gold standard surgical treatment for patients with chronic ankle instability (CAI) whose symptoms are refractory to conservative treatment. The purpose of this study is to investigate the relationship between preoperative radiographic alignment, intraoperative stress testing, concomitant pathology, and postoperative pain scores in patients undergoing Brostrom-Gould procedures. Specific questions included: 1) Is preoperative radiographic alignment predictive of the degree of lateral ankle instability noted intraoperatively? 2) Is the degree of ankle instability associated with the presence of OCD lesions and peroneal tendon pathology? 3) Is the degree of ankle instability associated with postoperative VAS pain? and 4) Does concomitant pathology affect final VAS pain score? Methods: A retrospective study was performed of all patients who underwent lateral ankle ligament reconstruction by a single surgeon from 2002 to 2020. Patients who underwent concomitant hindfoot fusion procedures or ankle arthroplasty were excluded. Demographic and clinical information was recorded from the electronic medical record. Preoperative radiographic measurements were taken using weightbearing ankle films. Intraoperative stress views were evaluated to determine the talar tilt. All data was tested for normality. Parametric and nonparametric univariate statistics were used to determine the relationship between preoperative weightbearing radiographic measurements, preoperative MRI findings, intraoperative talar tilt measurement, and postoperative outcomes. Results: 181 patients with a median follow-up of 1 year were included. Complications included delayed wound healing in 5.6%, superficial infection in 2.8%, and nerve symptoms in 11%. The reoperation rate was 5%, including revision lateral ankle ligament reconstruction (4/181), debridement for infection (1/181), and wound revision (4/181). Increased preoperative anterior distal tibial angle (ADTA) was associated with an increased intraoperative talar tilt (p=0.0073). Increased intraoperative talar tilt was associated with an increased prevalence of osteochondral lesions of the talus (p=0.0176). Mean VAS scores improved from 4.6 preoperatively to 1.9 postoperatively (p<0.0001). Neither the preoperative radiographic alignment nor the degree of intraoperative instability were predictive of final VAS score. Patients with osteochondral lesions had higher final VAS pain scores than patients without osteochondral lesions (p=0.0134). Conclusion: In patients undergoing lateral ankle ligament reconstruction for CAI, preoperative ankle alignment was associated with the degree of ankle instability. It is unclear if an increased ADTA predisposes to great instability, or if larger anterior distal tibia osteophytes are formed in patients with more severe instability, leading to a larger ADTA. Increased instability was associated with a higher rate of osteochondral lesions, and patients with osteochondral lesions tended to have more pain postoperatively. This information may be helpful in counseling patients regarding surgical treatment and postoperative expectations.