SLR - August 2019 - Jacob M. Perkins
Arthroscopic Suture-Tape Internal Bracing is Safe as Arthroscopic Modified Broström Repair in the Treatment of Chronic Ankle Instability
Reference: Ulku, T.K., Kocaoglu, B., Tok, O., Irgit, K. and Nalbantoglu, U., 2019. Arthroscopic Suture-Tape Internal Bracing is Safe as Arthroscopic Modified Broström Repair in the Treatment of Chronic Ankle Instability. Knee Surgery, Sports Traumatology, Arthroscopy, pp.1-6.
Scientific Literature Review
Reviewed By: Jacob M. Perkins, DPM
Residency Program: University of Florida Health – Jacksonville, FL
Podiatric Relevance: Chronic lateral ankle instability is a common pathology treated by foot and ankle surgeons. The procedures to treat it have been evolving, notably trending towards various minimally invasive techniques. Traditionally the modified Broström repair has been considered the gold standard for surgical treatment amongst many podiatric physicians, and conclusive evidence pointing towards viable alternatives remains to be had. With advances in arthroscopy and continual refining of technique, podiatric surgeons have been able to attempt alternative procedures to the Broström, such as suture-tape internal bracing, with goals of decreased post-operative morbidity and less stringent requirements of patient compliance. This study reviews 61 consecutive patients treated with either the Broström technique or suture-tape internal bracing techniques and compares their clinical outcomes.
Methods: A level II retrospective cohort study was performed for all patients who received either the Broström or suture-tape internal bracing technique. A total of 61 consecutive patients who underwent the Broström (31) or suture-tape internal brace (30) were identified that met the inclusion criteria and passed exclusion criteria. Patients were evaluated clinically after the end of an intermediate total follow-up time using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure score (FAAM) for sports activity. Radiographic evaluation additionally was used by performing anterior drawer and varus stress radiographs with a Telos device in 150 N. Talar tilt angles and anterior talar translation were measured preoperatively, at 1-year post-op, and in a final follow-up visit. Secondary outcomes measures included mean operation time and recurrence rate of instability.
Results: Both the Broström and the suture-tape internal bracing showed improvement in the FAOS scores but had no statistical difference for pre and post-op scores. The FAAM scoring revealed significant superiority in the suture-tape group. There were no significant differences in pre and post-stress radiographs. Operation time showed a significant difference in length with suture-tape being shorter. There was no significant difference in the recurrence rate of instability. Of note, the suture-taping technique did not require casting or bracing post-operatively.
Conclusions: The clinical outcomes measures shows comparable scores for both Broström and suture-tape techniques at intermediate-term follow-up times. Suture-tape techniques had superior scoring for FAAM measures. Suture-tape techniques can also provide decreased operation times and do not require casting, possibly providing increased patient compliance and earlier rehabilitation plans. This study reveals the progress of techniques for treating chronic lateral ankle instability and provides valuable, viable alternatives than the traditional gold standard of the Broström technique.