Clinical Evaluation of the Modified Brostrom-Evans Procedure to Restore Ankle Stability

Abstract

The modified Brostrom procedure has become the standard for anatomic repair of symptomatic chronic lateral instability. However, it was our perception that this local tissue repair may fail eventually, particularly in patients that are overweight, hyperflexible, or are involved in strenuous work or athletic activity. This is a retrospective review of 21 lateral ankle reconstructions (20 patients) in which the modified Brostrom technique was augmented with a portion of the peroneus brevis tendon. All patients were interviewed at an average of 29.5 months (range, 14-56 months postsurgery). Fourteen patients also agreed to be evaluated by a physical therapist. No surgical complications were identified. American Orthopaedic Foot and Ankle Society ankle-hindfoot scores averaged 98.2. There was no significant difference in passive or active range of motion of plantarflexion or dorsiflexion when compared to the contralateral ankle. However, a statistically significant loss of inversion (passive, P = 0.011; active, P = 0.018) and eversion (passive, P = 0.004; active, P = 0.007) was noted when compared to the contralateral ankle. Measurement of isometric eversion strength, using a Cybex 340 Isokinetic device, and functional testing, using a lateral lunge test, revealed no significant loss of peroneal strength. The authors conclude that chronic lateral ankle instability in the general population can be successfully managed with a modified Brostrom procedure augmented with a portion of the peroneus brevis. The procedure remains technically simple and provides a greater static restraint for inversion stress without evidence of dramatic overtightening or loss of peroneal strength.

Primary ankle ligament augmentation versus modified Brostrom-Gould procedure: a 2-year randomized controlled trial

“…There are a relatively large number of patients for whom the MBG is associated with a poorer outcome. This includes patients with generalized ligamentous laxity or joint hypermobility, long‐standing lateral ligament instability and failed previous surgery, as well as patients with adverse hindfoot biomechanics and high‐demand athletes …”

Return to Play Following Ankle Sprain and Lateral Ligament Reconstruction

“…For example, Evans 54 described in 1953 a transposition of the peroneus brevis tendon through a Shawen et al bone tunnel in the distal fibula followed by reattachment of the tendon to its remaining distal portion. Today this procedure is more commonly done, as described by Girard and colleagues, 55 using an anterior slip of the peroneus brevis as a checkrein, therefore avoiding complete disruption of the tendon and preserving most tendon function (Fig. 2).…”

Minimally Invasive Reconstruction of Anterior Talofibular Ligament with Partial Peroneus Brevis Tendon in the Treatment of Chronic Lateral Ankle Instability

“…Girard et al thought that the modified Brostrom would eventually fail in patients who were overweight or hyperflexible or engaged in strenuous work or athletic activities in the long run. 11 Barbari et al found cases in which lateral ligamentous structures were insufficient, making a repair impossible and reconstructed procedure necessary. 12 Watson-Jones and Chrisman-Snook procedures are the most frequently used techniques for correcting chronic lateral ankle instability in reconstructed procedures, and Watson-Jones tendonsis has been regarded as a better method compared with other techniques.…”