Suture Tape Augmentation in Lateral Ankle Ligament Surgery: Current Concepts Review

Abstract

Chronic lateral ankle instability (CLAI) is a condition that is characterized by persistent disability and recurrent ankle sprains while encompassing both functional and mechanical (laxity) instability. Failure of conservative treatment for CLAI often necessitates operative intervention to restore the stability of the ankle joint. The traditional or modified Broström techniques have been the gold standard operative approaches to address CLAI with satisfactory results; however, patients with generalized ligament laxity (GLL), prior unsuccessful repair, high body mass index, or high-demand athletes may experience suboptimal outcomes. Synthetic ligament constructs have been tested as an adjunct to orthopedic procedures to reinforce repaired or reconstructed ligaments or tendons with the hope of early mobilization, faster rehabilitation, and long-term prevention of instability. Suture tape augmentation is useful to address CLAI. Multiple operative techniques have been described. Because of the heterogeneity among the reported techniques and variability in postoperative rehabilitation protocols, it is difficult to evaluate whether the use of suture tape augmentation provides true clinical benefit in patients with CLAI. This review aims to provide a comprehensive outline of all the current techniques using suture tape augmentation for treatment of CLAI as well as present recent research aimed at guiding evidence-based protocols.

Keywords: Brostrom repair; instability; lateral ankle; outcomes; suture augmentation.

Figure 1.

Schematic of open Broström repair with suture tape augmentation. (A) A curved skin incision is made along the anterior and inferior borders of the lateral malleolus. The soft tissue is exposed to find the anterior talofibular ligament. (B) The anterior talofibular ligament is attached to the lateral malleolus by anchors, and two 3.5-mm anchors with suture tape are inserted into the fibula and talus. (C) The modified Broström repair with augmentation using suture tape is completed. 1-4: Anchors; 5: anterior talofibular ligament; 6: talus; 7: lateral malleolus; 8: suture tape. Source: Adapted from Xu et al. Copyright © 2019 The Authors. Orthopaedic Surgery, published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd. Used under CC BY-NC 4.0/ modified through rephrasing of figure legends A and B, changing text from past tense to present, and replacement of “1,2: SwiveLock anchor.3,4: Anchor.” In (c) with “1-4: Anchors,” replacement of “Swivelock” with “anchors” in (b).

Figure 2.

Schematic of arthroscopic Broström repair with suture tape augmentation (ABR-ST). (A) Arthroscopic images demonstrating use of anterolateral portals for anchor placement. The first anchor is inserted at 1 cm superior to its position on the fibula. The second anchor is placed into the fibula more superiorly and level with the lateral shoulder of the talus. The fibular tunnel is created for suture tape insertion in the fibula between 2 all-suture anchors through the anterolateral portal. (B) Schematic drawing of an arthroscopic modified Brostrom procedure with an internal brace. Source: Adapted from Yoo and Yang. Copyright © 2016 The Author(s), published with open access at Springerlink.com. Used under CY BY 4.0 / modified through changing text from past tense to present.

Figure 3.

Schematic of suture tape augmentation only (STO). (A) Intraoperative photograph showing the pathway and anatomic origin of the anterior talofibular and calcaneofibular ligaments. (B) Confirmation of entry points (dots) of suture anchors through temporary K-wires inserted under fluoroscopic guidance. (C, D) Postoperative radiographs showing the location of anchors and suture tape (arrows indicate the entry points of anchors). Source: Reprinted from Cho et al. Used under STM Permissions Guidelines 2020.