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Current Reviews in Musculoskeletal Medicine

Erschienen in:

07.11.2020 | Management of Ankle Instability (M Hogan, Section Editor)

Open Brostrom for Lateral Ligament Stabilization

verfasst von: Kenneth J. Hunt, Rebecca Griffith

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 6/2020

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Abstract

Purpose of Review

Lateral ankle ligament sprains are one of the most commonly reported injuries in high-level athletes and the general population. Unfortunately, up to 40% of these can go on to develop chronic lateral ankle instability which in the right circumstances requires surgical intervention. The purpose of this review is to present the gold standard surgical treatment for chronic lateral instability with anatomic ligament repair and to highlight the techniques, outcomes, and importance of anatomy when considering surgical treatment.

Recent Findings

Recent and remote literature agrees that the initial treatment for chronic ankle instability is non-operative rehabilitation. In the cases where this fails, the gold standard of surgical treatment is open anatomic repair using the Brostrom-Gould technique which stands out as having very good results over the course of time. Recent studies have shown equally good outcomes with arthroscopy as well as with internal brace devices, and both techniques show potential for earlier rehabilitation. In those with contraindications for anatomic repair including innate soft tissue laxity, high BMI, and in the revision setting, anatomic ligament reconstruction is an appropriate surgical option.

Summary

Open modified Brostrom lateral ligament repair continues to be the preferred method of surgical treatment for chronic lateral ligament instability. In the setting of new modifications and techniques, long-term outcome studies are necessary to identify both their usefulness in long term and to compare them to the open surgery outcomes. It would be useful to standardize rehabilitation protocols as well as return to sport metrics in order to better evaluate outcomes moving forward.

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•• Lee K, Jegal H, Chung H, Park Y. Return to play after modified broström operation for chronic ankle instability in elite athletes. CiOS Clin Orthop Surg. 2019;11:126–30 This study evaluated elite athletes with lateral ankle instability and reported return to play at three separate time points including return to personal training, team training, and actual game participation. 60 athletes were evaluated who had undergone the modified Brostrom procedure. The average age was 19.3 and the athletes were followed up at an average of 28.8 months. They were divided into two groups with one group returning early to play compared to the other. The return to personal training took a mean of 1.9 months, a mean of 2.9 months for team training, and 3.9 months for full game participation. Overall the return to play at 4 months was 83.3% and 100% 8 months after surgery.PubMed

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49.

•• Park S, Kim T, Lee M, Park Y. Absence of ATFL remnant does not affect the clinical outcomes of the modified Broström operation for chronic ankle instability. Knee Surg Sports Traumatol Arthrosc. 2019;28:213–20 Outcomes for the modified Broström are not wholly dependent on the quality of the remaining ATFL tissue present at time of surgery. In this retrospective cohort study, 60 patients with chronic ankle instability underwent evaluation of the ATFL remnant using ultrasound, MRI, and arthroscopy. After a mean follow-up of 30 months, there was no difference in the FAOS scores of subjects with or without an ATFL remnant when accounting for other variables using regression analysis. Remnant thickness was not found to correlate with FAOS scores. The study concluded that clinical outcomes of the modified Brostrom were found to be good regardless of the state of the ATFL remnant.PubMed

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53.

•• Vuurberg G, Pereira H, Blankevoort L, van Dijk CN. Anatomic stabilization techniques provide superior results in terms of functional outcome in patients suffering from chronic ankle instability compared to non-anatomic techniques. Knee Surg Sports Traumatol Arthrosc. 2018;26:2183–95 This systematic review article outlines the results of 19 articles which included 882 patients who had undergone a surgical procedure for chronic lateral ankle instability. They compared those that had an anatomic repair with those that underwent anatomic reconstruction or tenodesis. Anatomic repair showed the highest post-operative patient outcome scores and anatomic reconstruction showed the highest score increase from preop to postop. Both anatomic procedures had significantly better outcomes when compared to tenodesis.PubMed

Titel: Open Brostrom for Lateral Ligament Stabilization
verfasst von: Kenneth J. Hunt
Rebecca Griffith
Publikationsdatum: 07.11.2020
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 6/2020
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09679-z

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