The “All Inside” Arthroscopic Broström Procedure: A Prospective Study of 40 Consecutive Patients

doi:10.1053/j.jfas.2013.02.022

The Journal of Foot and Ankle Surgery

Volume 52, Issue 5, September–October 2013, Pages 568-574

https://doi.org/10.1053/j.jfas.2013.02.022 Get rights and content

Abstract

Lateral ankle sprains are the most common injury in sports. Nonoperative therapy is recommended initially, including functional rehabilitation. Surgery might be an option for those patients in whom nonoperative attempts fail. Various surgical approaches have been described in published studies for treating chronic lateral ankle instability. The procedures are typically grouped into 2 main categories: anatomic and nonanatomic repair of the lateral ligament complex. The open modified Broström-Gould anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. In the present study, we used an arthroscopic approach to treat chronic anterior talofibular ligament tears without the extensive open incisions common in the traditional modified Broström-Gould procedure. Our hypothesis was that the use of an all-inside arthroscopic Broström procedure would provide a minimally invasive technique with acceptable patient outcomes. We also wished to explore the complication rates and interval to return to weightbearing activity. A total of 40 ankles in 40 consecutive patients were included in the cohort.

Section snippets

Patients and Methods

A prospective study of 40 consecutive patients (40 ankles), treated from August 2011 to November 2012, with chronic lateral ankle instability was performed with a mean follow-up of 12.13 ± 4.27 (range 6 to 21) months. In all patients, a period of conservative treatment had failed, and all patients complained of continued pain and functional or mechanical instability preoperatively 5, 15. The patients were excluded from this technique if they had undergone a previous lateral ankle ligament

Surgical Technique

Each patient received a popliteal block administered by the anesthesia department preoperatively. The patient was then placed on the operating table in a supine position, and general anesthesia was administered. A well-padded thigh tourniquet was applied, and a thigh holder was positioned to have the foot elevated off the operating table a few inches. It is imperative to outline with a surgical marker the distal fibula, the course of the peroneal tendons, and the superficial peroneal nerve

Results

A total of 40 patients (40 ankles) underwent ankle arthroscopy with an “all-inside Broström” procedure. Of the 40 patients, 27 (67.5%) were females and 13 (32.5%) were males, with 15 (37.5%) right and 25 (62.5%) left ankles. The mean age was 45.6 (range 15 to 83) years. Mean follow-up was 12.13 ± 4.27 (range 6 to 21) months. The mean preoperative VAS pain score was 8.2 (range 4 to 10). The mean postoperative VAS pain score was 1.1 (range 0 to 5). The mean postoperative Karlsson–Peterson score

Discussion

Those patients whose injury is unresponsive to conservative modalities might require some form of stabilization of the lateral ankle ligament complex to alleviate their symptoms and resume activity. The Broström-Gould procedure has become a well-accepted standard in addressing primary stabilization for the typical patient (8). However, other pathologic features are frequently involved within the ankle joint itself that might not be addressed by an isolated Broström-Gould procedure.

In a recent

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Cited by (123)

Postoperative Magnetic Resonance Evaluation of Anterior Talofibular Ligament Following Arthroscopic Brostrom Procedure: Analysis and Outcomes of 40 Repairs at 12 Months
2024, Journal of Foot and Ankle Surgery
Lateral ankle sprains are one of the most common orthopedic injuries. When conservative treatment fails, surgical correction is often performed using either open or arthroscopic techniques. We hypothesize that MRI evaluation of the arthroscopic brostrom repair will show intact repair and decrease in thickness of the anterior talofibular ligament (ATFL) at 1 year, with statistically significant improvement of patient function and pain scores. Postoperative MRI was utilized at minimum 1-year follow-up to evaluate the integrity of the arthroscopic brostrom repair, as well as comparison of ATFL thickness to literature validated average thickness. A musculoskeletal fellowship trained radiologist performed all MRI reads. In addition, 3 fellowship trained foot and ankle specialists from a single institution all performed measurements of the ATFL. Surgical satisfaction using 1 to 100 scale, and Karlsson-Peterson (KP) were measured at 1 year postoperatively. In addition, pre- and postoperative Foot Function Index (FFI), American Orthopedic Foot and Ankle (AOFAS) hindfoot scores, and Visual Analog Scale (VAS) were measured using unpaired t tests. All repairs were shown to be intact at minimum 1-year follow-up via MRI evaluation, with ATFL thickness of 2.21 mm. Preoperative FFI, AOFAS, and VAS were 54.9, 46.4, and 7.1 respectively. Postoperative scores were 11.0, 91.7, and 1.3 respectively. Surgical satisfaction was 88.2, KP was 75.3. Comparison of pre- and postoperative scores (VAS, FFI, AOFAS) were shown to be statistically significant, p < .05. No significant difference in demographic data was observed at 1 year. The data from this study offers evidence that the arthroscopic brostrom repair provides patients with good outcomes as well as an intact ATFL with normal morphology at 1 year postoperatively.
Accuracy of Cutaneous Landmarks Compared to Ultrasound to Locate the Calcaneal Footprint of the CFL
2024, Journal of Foot and Ankle Surgery
The purpose was to determine the accuracy of the techniques of Lopes et al. and Michels et al., compared to ultrasound, to locate the center of the calcaneal footprint of the CFL in healthy volunteers. The authors recruited 17 healthy adult volunteers at 1 center with no current ankle pathologies and no previous surgical antecedents on either ankle. The authors recorded the age, sex, height, BMI, and ankle side for each volunteer. Measurements were made on both ankles of the 17 volunteers to increase the sample size and ensure less dispersion of data, independently by 2 surgeons: 1 senior surgeon with 15 years' experience and 1 junior with 3 years' experience. The location of the center of the calcaneal footprint of the CFL was determined by each surgeon using 3 methods: (1) the cutaneous technique of Lopes et al., (2) the cutaneous technique of Michels et al., and (3) ultrasound imaging. The 17 volunteers (34 feet) had a mean age of 26.3 ± 8.7 and a BMI of 21.7 ± 2.9. The Michels point was significantly closer (4.6 ± 3.7 mm) than the Lopes point (11.1 ± 5.4 mm) to the true center of the calcaneal footprint of the CFL determined by ultrasound, notably in the vertical direction. The Michels point was located significantly closer to the true center of the calcaneal footprint of the CFL and demonstrated less dispersion than the Lopes point, indicated by significantly lower absolute mean deviation from the true center of the calcaneal footprint of the CFL, and that ultrasound is therefore preferred to locate the footprint the CFL.
Arthroscopic Lateral Stabilization
2023, Clinics in Podiatric Medicine and Surgery
Determining the Feasibility of Arthroscopic Anterior Talofibular Ligament Repair Utilizing a Novel Classification System
2023, Journal of Foot and Ankle Surgery
The purposes of this study were to classify anterior talofibular ligament injuries (ATFL), to find out the feasibility of arthroscopic ATFL repair according to injury type and to investigate the diagnostic validity of magnetic resonance imaging (MRI) of ATFL injuries by comparing MRI and arthroscopic findings. The 197 ankles (93 right, 104 left, and 12 bilateral) of 185 patients (90 men and 107 women; mean age, 33.5 years, range: 15-68 years) were treated by arthroscopic modified Broström procedure after a diagnosis of chronic lateral ankle instability. ATFL injuries were classified according to their grade and location (type P: partial rupture, type C1: fibular detachment, type C2: talar detachment, type C3: midsubstance rupture, type C4: absence of ATFL, type C5: os subfibulare). Among the 197 injured ankles, according to ankle arthroscopy, 67 were type P (34%), 28 were type C1 (14%), 13 were type C2 (7%), 29 were type C3 (15%), 26 were type C4 (13%), and 34 were type C5 (17%). The kappa value for the agreement between the arthroscopic findings and MRI findings was also high (0.85; 95% confidence interval, 0.79-0.91). Our results also supported the use of MRI for diagnosing ATFL injuries and showed that it is an informative tool during the preoperative period.
Return to sports: Rate and time after arthroscopic surgery for chronic lateral ankle instability
2022, Revue de Chirurgie Orthopedique et Traumatologique
Le traitement de l’instabilité de cheville sous arthroscopie est de plus en plus populaire. Plusieurs études ont montré des résultats fonctionnels équivalents aux techniques à ciel ouvert, sans majoration des complications. L’objectif de cette étude était d’évaluer le taux et le délai de retour au sport après chirurgie arthroscopique pour instabilité latérale chronique de cheville. Notre hypothèse était que le taux et le délai de retour au sport étaient satisfaisants après cette chirurgie sous arthroscopie.
Il s’agissait d’une étude monocentrique, rétrospective ayant inclus les malades opérés d’une instabilité chronique de cheville sous arthroscopie sans geste associé, entre février 2014 et mai 2017. Nous avons évalué le taux, le délai et les facteurs associés à la reprise du sport en évaluant en particulier le niveau de motivation à la reprise, le niveau préopératoire et le cadre d’accident de travail. Le délai de révision minimal était d’un an.
Sur 40 patients inclus, 75 % ont repris leur sport principal avec un délai médian de 6 mois, dont 22 (55 %) à un niveau équivalent ou supérieur à 12 mois avec un suivi médian après la chirurgie de 29 mois (extrêmes 13–61). On notait une amélioration significative du score AOFAS passant de 67 [30–90] en pré-opératoire à 88,5 [39–100] au dernier recul (p < 0,001) et une diminution significative des douleurs sur l’EN passant de 6 [0–10] en pré-opératoire à 1 [0–10] au dernier recul (p < 0,001). La motivation élevée en préopératoire représentait le principal facteur significativement associé en analyse multivariable à un retour au sport à un niveau équivalent ou supérieur 12 mois après la chirurgie (OR : 11 ; IC 95 % 1,91—63,18, p = 0,007). Une douleur persistante était associée à un contexte d’accident de travail plus fréquent (p = 0,016).
Cette série a mis en évidence un taux de reprise du sport de 75 % à 12 mois (55 % à un niveau supérieur ou équivalent) avec un délai médian de 6 mois (4–8). Le taux et délai de reprise du sport étaient statistiquement associés à la motivation préopératoire.
IV ; étude rétrospective.
Return to sports: Rate and time after arthroscopic surgery for chronic lateral ankle instability
2022, Orthopaedics and Traumatology: Surgery and Research
Arthroscopic surgery for treating ankle instability is increasingly popular. Several studies showed similar functional outcomes to those seen after open surgery, with no increase in complications. The objective of this study was to evaluate the return-to-sports (RTS) rate and time after arthroscopic surgery to treat chronic lateral ankle instability.
The rate and time of RTS are satisfactory after arthroscopic surgery to treat chronic lateral ankle instability.
This single-centre retrospective study included patients managed arthroscopically for chronic lateral ankle instability, with no other procedures, between February 2014 and May 2017. We evaluated the time and rate of RTS, as well as factors associated with RTS such as motivation, athletic level before surgery and whether the injury was work-related. Follow-up was at least 1 year.
Of the 40 included patients, 30 (75%) returned to their main sport, after a median of 6 months. Moreover, 22 (55%) patients resumed their main sport at the same or a higher level within 12 months after surgery, their median postoperative follow-up being 29 months (range, 13–61). The AOFAS score improved significantly, from 67 (30–90) before surgery to 88.5 (39–100) at last follow-up (p < 0.001). The numerical pain score decreased significantly between these two timepoints, from 6 (0–10) to 1 (0–10) (p < 0.001). By multivariate analysis, a high level of motivation before surgery was the main factor significantly associated with RTS at the same or a higher level within 12 months after surgery (odds ratio, 16.47; 95%CI, 3.33–81.20; p = 0.007). Persistent pain was more common in patients with work-related injuries (p = 0.016).
At 12 months, the RTS rate was 75% overall, with 55% of patients returning to the same or a higher level. Median time to RTS was 6 months (4–8). Both the rate of and the time to RTS were independently associated with greater preoperative motivation.
IV, retrospective observational cohort study.

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: Financial Disclosure: None reported.

: Conflict of Interest: Dr. Cottom is a paid consultant for Arthrex, Inc., Naples, FL. Arthrex had no role in the design, data collection, or writing of this paper.

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Original ResearchThe “All Inside” Arthroscopic Broström Procedure: A Prospective Study of 40 Consecutive Patients

Abstract

Section snippets

Patients and Methods

Surgical Technique

Results

Discussion

Foot Ankle Clin North Am

Arthroscopy

Clin Podiatr Med Surg

Clin Podiatr Med Surg

Foot

Surgical treatment of the unstable ankle

J Am Acad Orthop Surg

The frequency of injury, mechanism of injury, and epidemiology of ankle sprains

Am J Sports Med

Sprained ankles, VI: surgical treatment of “chronic” ligament ruptures

Acta Chir Scand

Early and late repair of the lateral ligaments of the ankle

Foot Ankle

Arthroscopic lateral ankle ligament reconstruction

Tech Foot Ankle Surg

Arthroscopic repair of chronic lateral ankle instability

Foot Ankle Int

Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Broström repair using suture anchors

Am J Sports Med

A radiographic investigation to determine the safety of suture anchor systems for pediatric modified Broström ankle ligament reconstruction

Am J Sports Med

Original Research
The “All Inside” Arthroscopic Broström Procedure: A Prospective Study of 40 Consecutive Patients