Strength of Bone Tunnel Versus Suture Anchor and Push-Lock Construct in Broström Repair

Giza, Eric; Nathe, Ryan; Nathe, Tyler; Anderson, Matthew; Campanelli, Valentina

doi:10.1177/0363546512443947

Cited by 31 publications

(38 citation statements)

References 19 publications

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“…Ligament rupture in mid-substance was the most frequent mode of failure in the native ATFL group which confirms our test set-up to be effective in simulation of in vivo ankle sprain kinematics. Anchor pull-out is the most common mode of failure in biomechanical studies testing suture anchor reconstruction [ 16 , 17 , 34 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…In rotator cuff repair, low bone mineral density has been shown to have a significant impact on anchor failure [ 4 , 35 ]. There are a few biomechanical studies focussing on lateral ankle ligament reconstruction with suture anchors investigating the influence of BMD on construct stability [ 6 , 16 , 17 , 34 , 36 , 37 ]. Therefore, DEXA scans were performed in advance to assess the bone mineral density of the specimens, in order to question the influence of BMD on the mode of failure, torque at failure and angle at failure.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL

Willegger

Benca

Hirtler

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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PurposeCurrent methods of anterior talofibular ligament (ATFL) reconstruction fail to restore the stability of the native ATFL. Therefore, augmented anatomic ATFL reconstruction gained popularity in patients with attenuated tissue and additional stress on the lateral ankle ligament complex. The aim of the present study was to evaluate the biomechanical stability of the InternalBrace® (Arthrex Inc., Naples, FL, USA), a tape augmentation designed to augment the traditional Broström procedure. MethodsTwelve (12) fresh-frozen human anatomic lower leg specimens were randomized into two groups: a native ATFL (ATFL) and a tape augmentation group (IB). Dual-energy X-ray absorptiometry (DEXA) scans were carried out to determine bone mineral density (BMD) of the specimens. The ligaments were stressed by internally rotating the tibia against the inverted fixated hindfoot. Torque at failure (Nm) and angle at failure (°) were recorded.ResultsThe ATFL group failed at an angle of 33 ± 10°. In the IB group, construct failure occurred at an angle of 46 ± 16°. Failure torque reached 8.3 ± 4.5 Nm in the ATFL group, whereas the IB group achieved 11.2 ± 7.1 Nm. There was no correlation between angle at ATFL or IB construct failure or torque at failure, respectively, and BMD for both groups.ConclusionThis study reveals that tape augmentation for ATFL reconstruction shows similar biomechanical stability compared to an intact native ATFL in terms of torque at failure and angle at failure. BMD did not influence the construct stability. Tape augmentation proved an enhanced initial stability in ATFL reconstruction which may allow for an accelerated rehabilitation process.Level of evidence II.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL

Willegger

Benca

Hirtler

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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“…Suture anchors are most important for the evolving arthroscopic Brostrom techniques [29, 30]. The stability of anchor systems has been tested in cadaver studies, but the strength of these repairs was inferior to native ATFL [31–34]. Recently, suture tape techniques for augmentation of the ATFL were described [12, 35] and are proposed at least for patients with generalized ligamentous laxity [26], athletes, or patients with poor local tissue quality, e.g., following failed previous repair or reconstruction [13, 14].…”

Section: Discussionmentioning

confidence: 99%

Stabilizing lateral ankle instability by suture tape – a cadaver study

et al. 2019

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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.

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“…We know that transosseous tunnel fixation has the advantages of a larger contact area of the tendon with bone that can advance tendon healing in the bone tunnel and is less expensive than other implantation procedures. 30 31 32 We performed surgery on two ankles in which the CFL was avulsed from the calcaneus insertion during the period of data collection. The procedure was performed similarly; however, the fixation was performed with the interference screw at the calcaneus.…”

Section: Discussionmentioning

confidence: 99%

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

Weng

Chen

Tsuang

et al. 2018

IJOO

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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.

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Strength of Bone Tunnel Versus Suture Anchor and Push-Lock Construct in Broström Repair

Cited by 31 publications

References 19 publications

Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL

Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL

Stabilizing lateral ankle instability by suture tape – a cadaver study

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

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