Comparison of Midterm Outcomes between All-Inside Arthroscopic and Open Modified Broström Procedures as Treatment for Chronic Ankle Instability

Abstract

Background: Although the all-inside arthroscopic modified Broström operation (AMBO) and open modified Broström operation (OMBO) for chronic lateral ankle instability (CLAI) showed favorable outcomes up to 1-year short-term follow-up, concerns about the long-term stability of AMBO are still present. Therefore, we aimed to compare midterm outcomes between the 2 methods by extending the observation period.

Methods: Fifty-four patients undergoing ankle surgery between August 2013 and July 2017 were included in the AMBO (n = 37) and OMBO (n = 17) groups. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and a visual analog scale (VAS) were used to evaluate the clinical outcomes. Anterior drawer test and talar tilt angle were used to evaluate the radiological outcomes. The mean follow-up duration was 59.69 months.

Results: The 2 groups both showed improved clinical and radiological results statistically. In addition, they did not differ in age, sex, or preoperative AOFAS ankle-hindfoot scale score, VAS score, anterior drawer test, or talar tilt angle. No significant difference in the final follow-up postoperative clinical scores or radiological outcomes was observed.

Conclusions: AMBO and OMBO as treatments for CLAI did not yield differing clinical or radiological outcomes at a mean follow-up time point of 59.69 months.

Keywords: All-inside arthroscopic modified Broström operation; Chronic lateral ankle instability; Open modified Broström operation.

Fig. 1. Consort flowchart. LAI: lateral ankle instability, MBO: modified Broström operation.

Fig. 2. Photographs of the foot during open modified Broström operation (OMBO). Surgical procedures of the OMBO are shown. (A) A curved incision measuring 5 cm is meticulously placed immediately anterior to the fibular border. (B) The redundant portion of the anterior talofibular ligament is judiciously excised, and the residual tissues are meticulously reconstructed utilizing 2-0 Ethibond sutures. Following the repair, the extensor retinaculum was utilized to enhance reinforcement, securing it to the periosteum over the fibula through the application of the “pants-over-the-vest” technique. (C) After repair, a thorough assessment of stability is conducted, culminating in the closure of the incision.

Fig. 3. Photographs of the foot during arthroscopic modified Broström operation (AMBO). Surgical procedures of the all-inside AMBO are shown. (A) A drill hole is created perpendicular to the anterior surface of the fibula, through which an anchor is carefully inserted via the anterolateral portal. A singular absorbable Bio-Suture Tak anchor, affixed with 2 sutures (3.0 mm), is deployed. To secure the anchor’s wire, an accessory anteroinferior portal is established in the vicinity of the sinus tarsi. Additionally, a far-lateral portal is meticulously fashioned over the anterior fibula. (B) A penetrator, adeptly grasping one end of the sutures, traverses from the anterolateral portal to the accessory anteroinferior portal intra-articularly. Simultaneously, the other end of each suture is drawn through the far-lateral portal using the penetrator. A suture retriever is introduced through the far-lateral portal to the accessory anteroinferior portal. (C) The final tightening of the knot marks the meticulous completion of the procedure.