Background
Modification of the Bröstrom repair using suture tape as an internal brace for ligament augmentation has been used to address chronic lateral ankle instability. Results of application of an internal brace for anterior talofibular ligament (ATFL) repair augmentation have been promising. However, there are only a few studies in the literature reporting either functional outcomes or return to sport activity after this procedure. Additionally, there is limited data on return to sport clinical outcomes after fixation of both the ATFL and calcaneofibular ligament (CFL).
Purpose
To evaluate the return to activities of daily living and sport after modification of the Brostöm repair procedure, specifically using one internal brace for fixation of both the ATFL and CFL.
Methods
This is a retrospective case series evaluating 31 patients who had grade III ankle sprains and lateral ankle instability, all of whom failed at least a six-month course of supervised conservative management. These patients underwent a modified Brostro¨m procedure consisting of suture anchors and augmentation of both the ATFL and the CFL using an internal brace. For clinical outcome evaluation, the FAAM Activites of Daily Living (ADL) subscale, FAAM Sports Subscale, and Karlsson scoring questionnaires coupled with questions regarding the time of the return to sport and level of sports activity were employed. Level of clinical evidence is 4.
Results
The mean post-operative score for the FAAM ADL subscale was 77.49 out of 84 possible points, a significant improvement from the mean pre-operative score of 46.06 (P<0.00001). The mean post-operative score for the FAAM Sports sub scale was 19.31 out of 28 possible points, a significant improvement from the mean pre-operative score of 4 (P<0.00001). For the Karlsson and Peterson scoring system for ankle function was also analyzed, patients reported a mean of 82.74 points out of the possible 100 post-operatively. Among the 31 patients surveyed, none were professional athletes, while 14 engaged in recreational sports activity. Of the 14 patients who played recreationally, 12 of them were able to resume activity in less than 12 months post-op. The mean time to return to sport activity was 5.72 months post-op. The mean age of the surveyed patient population was 40.70 years. The mean follow-up time was 24.06 months.
Conclusion
This proposed variant of the Broström procedure with suture anchors and augmentation of both the ATFL and CFL was effective in helping patients with chronic lateral ankle instability return to their pre-injury functionality level in both daily life and sports activity.
Disclosures:
Military Identification: Benjamin C Murray, LT, MC, USN, NMRTCP
Non-research disclaimer: The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
Research Disclaimer: The views expressed in this abstract reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
Copyright Statement: I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.
Research IRB Approval Statement: The study protocol was approved by the Royal Oak Beaumont Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.
Funding Acknowledgement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.