Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
권호 표지
DOI QR코드

DOI QR Code

Early Unrestricted Weight-Bearing in a Stirrup Brace Following the Broström Procedure with Suture Tape for Chronic Lateral Ankle Instability

족관절 외측의 만성 불안정성에 Broström 술식과 Suture Tape을 이용한 보강술 후 조기에 시행한 등자보호대 착용 및 체중부하 보행

  • Jaeyoung, Lee (Department of Orthopedic Surgery, The Catholic University of Korea, Bucheon St. Mary's Hospital) ;
  • Geon-Ho, Kwon (Department of Orthopedic Surgery, The Catholic University of Korea, Bucheon St. Mary's Hospital) ;
  • Jin-Wha, Chung (Department of Orthopedic Surgery, The Catholic University of Korea, Bucheon St. Mary's Hospital)
  • 이재영 (가톨릭대학교 부천성모병원 정형외과) ;
  • 권건호 (가톨릭대학교 부천성모병원 정형외과) ;
  • 정진화 (가톨릭대학교 부천성모병원 정형외과)
  • Received : 2022.10.27
  • Accepted : 2022.11.14
  • Published : 2022.12.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study reports on a series of patients with chronic lateral ankle instability that underwent the Brostrom procedure with suture tape augmentation and allowed early unrestricted weight-bearing in a simple stirrup brace. Materials and Methods: This retrospective study was conducted on 36 patients (22 males and 14 females of mean age 34 years [range 23~48 years]) with chronic lateral ankle instability treated using the Brostrom procedure using suture tape augmentation and inferior extensor retinaculum reinforcement with a fiber-wire connected to a SwiveLock screw inserted into the talus. When possible, patients started unrestricted weight-bearing in a stirrup brace from the third postoperative day. Demographics and functional outcomes, including American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, visual analogue scale (VAS), and satisfaction scores, were recorded. In addition, varus stress radiographs obtained before and 24 months after surgery were compared. Patients were followed for a mean 29 months (range 25~40 months). Results: Mean AOFAS ankle-hindfoot scores increased from 51 points preoperatively to 92 points at final follow-up, and mean VAS decreased from 6.8 to 1.2 points. Mean patient satisfaction scores were 8.7 at 12 months and 9.6 at 24 months. Stress radiographs demonstrated that talar tilt decreased from a mean 18 degrees preoperatively to 7 degrees at 24 months. Conclusion: Early unrestricted weight-bearing in a stirrup brace following the Brostrom procedure with suture tape augmentation is a successful protocol for treating chronic lateral ankle instability.

Keywords

References

  1. Gerstner Garces JB. Chronic ankle instability. Foot Ankle Clin. 2012;17:389-98. doi: 10.1016/j.fcl.2012.06.001.
  2. Holmer P, Sondergaard L, Konradsen L, Nielsen PT, Jorgensen LN. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int. 1994;15:72-4. doi: 10.1177/107110079401500204.
  3. Harrington KD. Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. J Bone Joint Surg Am. 1979;61:354-61. https://doi.org/10.2106/00004623-197961030-00006
  4. Karlsson J, Eriksson BI, Renstrom P. Subtalar instability of the foot. A review and results after surgical treatment. Scand J Med Sci Sports. 1998;8:191-7. doi: 10.1111/j.1600-0838.1998.tb00191.x.
  5. Valderrabano V, Hintermann B, Horisberger M, Fung TS. Ligamentous posttraumatic ankle osteoarthritis. Am J Sports Med. 2006;34:612-20. doi: 10.1177/0363546505281813.
  6. Aydogan U, Glisson RR, Nunley JA. Extensor retinaculum augmentation reinforces anterior talofibular ligament repair. Clin Orthop Relat Res. 2006;442:210-5. doi: 10.1097/01.blo.0000183737.43245.26.
  7. Brostrom L. Sprained ankles. VI. Surgical treatment of "chronic" ligament ruptures. Acta Chir Scand. 1966;132:551-65.
  8. Cho BK, Kim YM, Shon HC, Park KJ, Cha JK, Ha YW. A ligament reattachment technique for high-demand athletes with chronic ankle instability. J Foot Ankle Surg. 2015;54:7-12. doi: 10.1053/j.jfas.2014.09.008.
  9. Gould N, Seligson D, Gassman J. Early and late repair of lateral ligament of the ankle. Foot Ankle. 1980;1:84-9. doi: 10.11 77/107110078000100206. https://doi.org/10.1177/107110078000100206
  10. Maffulli N, Del Buono A, Maffulli GD, Oliva F, Testa V, Capasso G, et al. Isolated anterior talofibular ligament Brostrom repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med. 2013;41:858-64. doi: 10.1177/0363546512474967.
  11. Kirk KL, Campbell JT, Guyton GP, Parks BG, Schon LC. ATFL elongation after Brostrom procedure: a biomechanical investigation. Foot Ankle Int. 2008;29:1126-30. doi: 10.3113/FAI.2008.1126.
  12. Waldrop NE 3rd, Wijdicks CA, Jansson KS, LaPrade RF, Clanton TO. Anatomic suture anchor versus the Brostrom technique for anterior talofibular ligament repair: a biomechanical comparison. Am J Sports Med. 2012;40:2590-6. doi: 10.1177/0363546512458420.
  13. Keene DJ, Williamson E, Bruce J, Willett K, Lamb SE. Early ankle movement versus immobilization in the postoperative management of ankle fracture in adults: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2014;44:690-701, C1-7. doi: 10.2519/jospt.2014.5294.
  14. Petrera M, Dwyer T, Theodoropoulos JS, Ogilvie-Harris DJ. Short- to medium-term outcomes after a modified Brostrom repair for lateral ankle instability with immediate postoperative weightbearing. Am J Sports Med. 2014;42:1542-8. doi: 10.1177/0363546514530668.
  15. Hermanns C, Coda R, Cheema S, Vopat ML, Bechtold M, Tarakemeh A, et al. Review of variability in rehabilitation protocols after lateral ankle ligament surgery. Kans J Med. 2020;13:152-9. doi: 10.17161/kjm.v13i.13820.
  16. Coetzee JC, Ellington JK, Ronan JA, Stone RM. Functional results of open Brostrom ankle ligament repair augmented with a suture tape. Foot Ankle Int. 2018;39:304-10. doi: 10.1177/1071100717742363.
  17. Jeong BO, Kim MS, Song WJ, SooHoo NF. Feasibility and outcome of inferior extensor retinaculum reinforcement in modified Brostrom procedures. Foot Ankle Int. 2014;35:11 37-42. doi: 10.1177/1071100714543645.
  18. Dalmau-Pastor M, Malagelada F, Kerkhoffs GMMJ, Manzanares MC, Vega J. X-shaped inferior extensor retinaculum and its doubtful use in the Brostrom-Gould procedure. Knee Surg Sports Traumatol Arthrosc. 2018;26:2171-6. doi: 10.1007/s00167-017-4647-y.
  19. Kubiak EN, Beebe MJ, North K, Hitchcock R, Potter MQ. Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg. 2013;21:727-38. doi: 10.5435/JAAOS-21-12-727.
  20. El-Akkawi AI, Joanroy R, Barfod KW, Kallemose T, Kristensen SS, Viberg B. Effect of early versus late weightbearing in conservatively treated acute Achilles tendon rupture: a meta-analysis. J Foot Ankle Surg. 2018;57:346-52. doi: 10.1053/j.jfas.2017.06.006.
  21. Karlsson J, Bergsten T, Lansinger O, Peterson L. Lateral instability of the ankle treated by the Evans procedure. A long-term clinical and radiological follow-up. J Bone Joint Surg Br. 1988;70:476-80. doi: 10.1302/0301-620X.70B3.3372575.
  22. Lundeen GA, Diefenbach C, Moles LH, White LL, Barousse P. Immediate unrestricted weightbearing with simple stirrup brace following single anchor lateral ankle ligament stabilization. Foot Ankle Spec. 2022;15:456-63. doi: 10.1177/1938640020972829.
  23. Martin KD, Andres NN, Robinson WH. Suture tape augmented Brostrom procedure and early accelerated rehabilitation. Foot Ankle Int. 2021;42:145-50. doi: 10.1177/1071100720959015.
  24. Mackay GM, Blyth MJ, Anthony I, Hopper GP, Ribbans WJ. A review of ligament augmentation with the InternalBraceTM: the surgical principle is described for the lateral ankle ligament and ACL repair in particular, and a comprehensive review of other surgical applications and techniques is presented. Surg Technol Int. 2015;26:239-55.