Mid-term follow-up evaluation of a new arthroscopic Broström procedure for chronic lateral ankle instability

Abstract

Background: Chronic lateral ankle instability (CLAI) usually progresses from a previous lateral ankle sprain that was not treated properly. Several procedures have been introduced to address these patients, including open or arthroscopic techniques, the most common of which is the Broström procedure. Here, we describe a new outside-in arthroscopic Broström procedure and its results for treating patients with CLAI.

Methods: Thirty-nine patients (16 male and 23 female; mean age, 35 years [range, 16-60 years]) with CLAI were treated arthroscopically after failing non-operative management. All patients were symptomatic with a combination of recurrent ankle sprains, "giving way," and avoidance of sports and presented with a positive anterior drawer test upon the physical examination. All patients underwent arthroscopic lateral ligament reconstruction using the new technique. Patient characteristics and pre- and postoperative visual analog scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale system (AOFAS), and Karlsson scores were recorded.

Results: The mean AOFAS score increased from 48 (mean 48, range 33-72) preoperatively to 91 (mean 91, range 75-98) at the final follow-up, Karlsson-Peterson and FAAM scores were also significantly improved. Two patients (5.13%) reported superficial peroneal nerve irritation symptoms postoperatively. Three patients (7.69%) complained of mild pain anteroinferior to the lateral ankle.

Conclusions: The arthroscopic outside-in Broström procedure with a single suture anchor was a safe, effective, and reproducible technique for CLAI. Ankle stability resumed with a high clinical success rate. The main complication was injury to the superficial peroneal nerve, which crossed the area of repair.

Keywords: Ankle arthroscopy; Chronic ankle instability; Ligament repair; Treatment.

Fig. 1

Arthroscopic vision showing the ATFL remnant is separated from the bone with the help of a beaver blade introduced through the anterolateral portal arthroscopic ligament repair (left ankle). (1) Fibula. (2) ATFL remnant. (3) Lateral wall of the talus

Fig. 2

Arthroscopic vision showing anchor introduction, needle used as a suture lasso and reconstructed ligament

Fig. 3

Location of arthroscopic lateral portals and anchor suture for ligament reconstruction

Fig. 4

Diagram of the ankle joint after completion of arthroscopic procedure with a single suture anchor