Enhancing Post-Surgical Rehabilitation Outcomes in Patients with Chronic Ankle Instability: Impact of Subtalar Joint Axis Balance Exercises Following Arthroscopic Modified Broström Operation

Abstract

Background and Objectives: This study aimed to evaluate the effects of subtalar joint axis-based balance exercises on the anterior talofibular ligament (ATFL) thickness, ankle strength, and ankle stability after an arthroscopic modified Broström operation (AMBO) for chronic ankle instability (CAI). Materials and Methods: The study included 47 patients diagnosed with CAI who underwent AMBO and were randomly divided into three groups: control (n = 11), general balance exercise (n = 17), and subtalar joint axis balance exercise (n = 19), regardless of the affected area. Participants in the exercise rehabilitation group performed exercises for 60 min twice a week for six weeks, starting six weeks after AMBO. ATFL thickness, ankle strength, and ankle dynamic stability were measured using musculoskeletal ultrasonography, Biodex, and Y-balance test, respectively, before and after treatment. Results: Compared with the remaining groups, the subtalar joint axis balance exercise group had reduced ATFL thickness (p = 0.000), improved ankle strength for eversion (p = 0.000) and inversion (p = 0.000), and enhanced ankle stability (p = 0.000). Conclusions: The study results suggest that subtalar joint axis-based balance exercises may contribute to the early recovery of the ankle joint after AMBO.

Keywords: anterior talofibular ligament; arthroscopic modified Broström operation; chronic ankle instability; subtalar joint axis balance exercises.

Figure 1

SBE applies balance movements to the foot in the direction of the subtalar joint axis using a circular pedalo to activate ankle eversion muscles, inversion muscles, lisfranc joint, and chopart joint movements (Pedalo^®, Grasleben, Germany). SBE: subtalar joint axis balance exercise.

Figure 2

Ultrasonography for the extensor retinaculum and anterior talofibular ligament. The double dashed arrow is a musculoskeletal ultrasound image of the extensor retinaculum and anterior talofibular ligament thickness measurement (scale bar = 5 mm). (A) Ultrasound image after 6 weeks of AMBO, (B) ultrasound image after 12 weeks of AMBO and after balance exercise for 6 weeks. AMBO, arthroscopic modified Broström operation, FAB: fibula anterior border, TN: talus neck.