SLR - August 2010 - Susan Orabovic
Reference:
Bynum J, Crates J, Aziz-Jacobo J, Barber FA., Modified Brostrom Technique Using Knotless Suture Anchors. Tech Foot and Ankle 2010 ; 9: 29-31
Scientific Literature Reviews
Reviewed by: Susan Orabovic, DPM PGY-III
Residency Program: UHHHS and Ohio College of Podiatric Medicine
Podiatric Relevance:
This study discusses the technique of a modified Brostrom procedure with knotless suture anchors to prevent the problems associated with subcutaneous knot irritation.
Methods:
This study evaluated 15 patients with lateral ankle instability who underwent a modified Brostrom technique. Following the standard procedure technique, 3 1.8mm pilot holes were drilled in the anterior edge of the distal fibula in the ATFL footprint. The goal was for theses drill holes to accommadate the knotless 2.5 x 8 mm biodegradable PushLock suture anchors. Three FiberWire mattress sutures (Size 0 or Size 2) were placed in the ATFL approximately 1cm from the released tissue edge. The fiberwire ends were then threaded through the anchor and sutured with the proper amount of tension in the proper placement.
Results:
Patients were initially placed in a short leg cast for 1 week followed by weight bearing as tolerated in a boot for the next 4 weeks. After 5 weeks, patients were protected in an ankle brace. Physical therapy consisted of passive range of motion and limited active range of motion with progression to active range of motion and isometric excercises. Each patient had been followed for over a one-year period, and no failures were reported at the time of publication. Also, no patients had any complaints of knot irritation. A larger prospective study is expected to be performed at a later date.
Conclusions:
This new technique of the Brostrom reconstruction utilizing suture anchors has thus far had good results and low complication rates. This technique improves the suture anchor technique by addressing concerns about subcutaneous knot irritation which has been a source of post-surgical patient dissatisfaction in the past. Future biomechanical studies will be performed addressing the failure rate and pullout strength of the anchors to further validate this technique.