SLR - August 2009 - Carissa Sharpe
Reference:
Li, S., Killie, H., Guerrero, P., Busconi, B. (2009). Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete; Functional outcomes after the modified bröstrom repair using suture anchors. The American Journal of Sports Medicine, 37(3), 488-494.
Scientific Literature Reviews
Reviewed by: Carissa L. Sharpe, DPM
Residency Program: OCPM-UHHS Richmond Medical Center
Podiatric Relevance:
This study provides useful data for the podiatric surgeon treating lateral ankle instability to decide upon the appropriate procedure of choice for the high demand athlete, with the goal of returning to pre-injury level of performance, as well as maintaining ankle joint motion and stability.
Methods:
This study consisted of sixty-two competitive athletes with grade III lateral ankle sprains. Each patient had failed a six-month course of conservative therapy including rest,
immobilization, medications, and formal physical therapy. Each patient was examined preoperatively and given a history and physical exam, as well as questionnaires at the sixmonth, one-year, and two-year follow-up appointments. The surgical procedure utilized a variant of the Gould-modified Brostrom procedure with three suture anchors. The suture anchors were inserted at the ATFL and CFL insertions on the distal fibula, and the third anchor placed about one centimeter above the ATFL insertion. One orthopedic surgeon conducted the treatment to ensure similar surgical technique.
Results:
The lateral ankle stability procedure was performed on a total of sixty-two patients. Ten of the sixty-two patients were lost to follow-up after cast removal. Forty-nine of the fifty-two patients returned to their pre-injury evaluation within two years after the operation. Major complications, at a six percent rate, included three re-ruptures and no neurovascular injuries. These three patients were competitive athletes with the acute injury occurring during competition. Minor complications, at a 12 percent rate, included decreased range of motion and infection. Three patients experienced superficial wound infections, managed and eliminated with oral antibiotics. Range of motion in all but three patients was equal to the contralateral ankle at the two-year follow-up appointment.
Conclusions:
Highly competitive athletes require a very stable constructed ankle in order to return to their pre-injury level of function after an acute injury. This variant of the Gouldmodified Brostrom procedure utilizing a third suture anchor as fixation allows the athlete to function at his or her pre-injury level, while maintaining motion and stability.