Stabilizing lateral ankle instability by suture tape – a cadaver study

Abstract

Background Suture tape is a recent development to augment a Brostrom repair at least during the healing phase of the native tissues used for stabilization of the lateral ankle ligaments. The purpose of this study was to evaluate whether suture tape is an effective mechanical stabilizer against anterior talar drawer in a cadaver experiment when tested with a validated arthrometer. Methods Different stability conditions were created in 14 cadaveric foot and leg specimens. Following anterior talofibular ligament (ATFL) dissection, isolated suture tape ATFL reconstruction was compared to the unaltered specimens, to the condition with ATFL cut, to the ATFL plus calcaneofibular ligament (CFL) cut conditions, and to the ATFL, CFL, and posterior talofibular ligament transected specimens. Three-dimensional bone-to-bone movement between fibula and calcaneus were simultaneously recorded using bone pin markers. Anterior translation was analysed between 20 and 40 N anterior talar drawer load, applied by an ankle arthrometer. Test conditions were compared using non-parametric statistics. Results Dissection of ATFL increased anterior talar drawer in arthrometer and bone pin marker analyses ( p = 0.003 and 0.004, respectively). When the CFL was additionally cut, no further increase of the anterior instability could statistically be documented ( p = 0.810 and 0.626, respectively). Following suture tape reconstruction of the ATFL, stability was not different from the unaltered ankle ( p = 0.173). Conclusions Suture tape augmentation of the ATFL effectively protects the unstable anterolateral ankle in the sagittal plane. The CFL does not seem to stabilize against the anterior talar drawer load.

Improved Outcome and Earlier Return to Activity After Suture Tape Augmentation Versus Broström Repair for Chronic Lateral Ankle Instability? A Systematic Review

“…34 Thus, it was J o u r n a l P r e -p r o o f hypothesized that suture tape augmentation could improve ankle stability by increasing stability of the reconstructed ATFL and protecting the ligament. 15,16,17,18,19 A cadaveric study by Viens et al 6 was able to demonstrate that strength and stiffness of the suture tape augmented construct was not significantly different to the native ATFL.…”

“…13,14 Suture tape augmentation or "internal bracing" is performed by using ultra high molecular weight polyethylene/polyester (UHMWPE) tapes and knotless bone anchors that are supposed to contribute to scar tissue formation by restoration of ankle stability and hence protect the repaired ligament during healing. 15,16,17,18,19 The aim of this study was to determine whether the use of suture tape augmentation would lead to improved clinical outcomes, increased stability, shorter postoperative immobilization J o u r n a l P r e -p r o o f and earlier return to activity and sports compared to Broström repair in surgical treatment of chronic lateral ankle instability (CLAI).…”

Suture Tape Augmentation in Lateral Ankle Ligament Surgery: Current Concepts Review

“…80 Two other cadaveric studies similarly found equal or better performance in the BR-ST group as measured by torque angle and total torque at failure. 71,83 Other biomechanical studies have noted the restoration of midfoot and hindfoot kinematics after BR-ST. 7, 50 Boey et al 7 used 3-D motion capture to measure range of motion (ROM) and average angle (AA) after rupture of sutureaugmented repair of ATFL, CFL, or both. All groups repaired with suture tape augmentation were able to at least partially restore foot and ankle kinematics, with the combined ATFL-CFL repair group achieving the best results.…”

AOFAS and Karlsson-Peterson scales in evaluating patients treated with modified Broström-Gould and suture tape augmentation for ankle instability: a performance analysis

“…The results of MBG plasty with suture tape augmentation are superior to those of standard techniques (3,4,21,23) . Suture tape provides an increased mechanical stability to the ankle that helps prevent recurrence of injury to the lateral ligaments and underlying structures, improves functional stability, and optimizes active rehabilitation (21) .…”