SLR - May 2010 - Jennifer Gerteisen
Reference:
Li, X., Lin, T., Busconi, B. (2009). Treatment of chronic lateral ankle instability: A modified broström technique using three suture anchors. Journal of Orthopaedic Surgery and Research, 4, 41.
Scientific Literature Review
Reviewed by: Jennifer Gerteisen, DPM
Residency Program: St John Hospital and Medical Center; Detroit, MI
Podiatric Relevance:
This study describes an alternative surgical technique to treat chronic lateral ankle instability, with particular attention paid to shortening the recovery time for competitive athletes.
Methods:
Fifty-two patients were included in this retrospective study design. All patients had chronic ankle instability of greater than six-months duration which was not alleviated by at least six months of physical therapy. Radiographic stress views and MRI findings also correlated pathology of the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments. Patient with fractures, osteochondral defects or previous surgical attempts at stabilization were excluded. The surgical technique involved placement of three absorbable Mitek suture anchors in a decorticated area of the distal fibula in an arch pattern with anchors facing the ATFL and CFL and the third placed one centimeter superior to the ATFL insertion. Repair of the ligaments and capsule were then performed with the foot everted and dorsiflexed. Postoperative course involved non-weightbearing for two weeks then protected weightbearing for an additional two in a removeable walking cast, and then physical therapy and weightbearing in an ankle support orthosis for weeks 4-6. The return to weightbearing and athletic activity was modified for highly competitive athletes.
Results:
Forty-nine patients had a decreased in range of motion of greater than 5 degrees at two years after surgery along with no loss of subtalar joint motion. Three patients experienced major complication of re-rupture secondary to traumatic injuries in competition. Minor complications such as superficial wound infections and persistent edema also occurred and resolved with treatment and without further complication.
Conclusions:
The basis of the findings demonstrates a stable alternative in the treatment of chronic refractory ankle instability. It incorporates an anatomic reconstruction which allows patients to return to their normal functional level.