Clinical Outcomes of Open Versus Arthroscopic Broström Procedure for Lateral Ankle Instability: A Meta-analysis

Moorthy, Vikaesh; Sayampanathan, Andrew Arjun; Yeo, Nicholas Eng Meng; Tay, Kae Sian

doi:10.1053/j.jfas.2020.10.001

Cited by 34 publications

(18 citation statements)

References 34 publications

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“…The Brostrom-Gould procedure has become known as the benchmark surgical procedure for lateral ankle ligament repair because of a multitude of studies demonstrating favorable long-term outcomes compared with other anatomic and nonanatomic repair techniques. 14 , 16 – 18 The clinical outcomes of this study including wound complications and recurrence of instability are all largely comparable with those in literature and add to the body of literature illuminating the satisfactory clinical results of the open modified Brostrom-Gould. 12 , 15 , 22 , 25 , 32 – 34 However, little is known about the factors effecting the intermediate outcomes of the Brostrom-Gould repair as measured by new patient-reported outcomes instruments.…”

Section: Discussionsupporting

confidence: 71%

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Impact of Patient Resilience on Outcomes of Open Brostrom-Gould Lateral Ligament Repair

et al. 2021

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Introduction: Little is known about the factors affecting the intermediate outcomes of the Brostrom-Gould repair as measured by new patient-reported outcome instruments and the impact of patient resilience on postoperative outcomes. This is the first study to investigate the impact of resilience on the outcomes of lateral ligament repair. Methods: Retrospectively, 173 patients undergoing Brostrom-Gould at single institution from January 2013 to June 2020 were identified. Patient characteristics, participation in athletic activities, surgical variables, and complications were recorded. Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference v1.1 (PI), Physical Function v1.2 (PF), and the Foot Ankle Ability Measure (FAAM) were collected. The Brief Resilience Scale was used to quantify resilience. A linear regression model was constructed to evaluate the independent effect of resilience on each PROMIS and FAAM outcome instrument. Variables were included in the regression model based on an a priori significance threshold of P <0.05 in bivariate analysis. Results: Resilience's independent effect on outcome measures was as follows: PROMIS PF (unstandardized β 8.2, 95% confidence interval [CI] 3.9 to 12.6), PROMIS PI (unstandardized β −4.8, 95% CI −7.9 to −1.7), FAAM Activities of Daily Living (unstandardized β 16.6, 95% CI 8.7 to 24.6), and FAAM Sports (unstandardized β 28.4, 95% CI 15.9 to 40.9). Preoperative participation in athletic activities also had a positive independent effect on multiple outcome metrics including PROMIS PF (unstandardized β 9.4, 95% CI 2.8 to 16.0), PROMIS PI (unstandardized β −5.3, 95% CI −10.0 to −0.582), and FAAM Sport scores (unstandardized β 34.4, 95% CI 15.4 to 53.4). Conclusions: Resilience and patient participation in athletic activities are independent predictors of improved postoperative functional outcomes as measured by PROMIS and FAAM instruments at intermediate term follow-up. Resilient patients and athletes reported markedly higher PF and less pain burden postoperatively. Preoperative quantification of resilience could enable improved prognostication of patients undergoing lateral ligament repair of the ankle.

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Section: Discussionsupporting

confidence: 71%

“… 11 The Brostrom-Gould technique is considered the benchmark in treatment of chronic lateral ankle instability with excellent short- and long-term outcomes. 12 13 14 15 16 17 18 …”

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confidence: 99%

Impact of Patient Resilience on Outcomes of Open Brostrom-Gould Lateral Ligament Repair

et al. 2021

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“…29 Both methods stabilize the ankle by repairing the lateral ankle ligament. 15,28 Although varus tilt of the distal tibial plafond and hindfoot varus alignment are risk factors for CLAI, 12,19 it is unclear whether they influence outcomes after arthroscopic lateral ankle ligament repair (ALLR). We previously reported that varus tilt of the distal tibial plafond alignment induces recurrent ankle sprain after ALLR.…”

Section: Introductionmentioning

confidence: 99%

“…However, approximately 20% of these people experience a condition called chronic lateral ankle instability (CLAI) that lasts for a long time. 5,15 Patients with CLAI usually report repeated episodes of instability, with their ankles “giving way.” 1,8 These patients are advised to undergo surgery when nonoperative management fails.…”

Section: Introductionmentioning

confidence: 99%

Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair

et al. 2023

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Background: Hindfoot varus deformity is a known risk factor for chronic lateral ankle instability (CLAI). The impact of this deformity on clinical results following arthroscopic lateral ankle ligament repair (ALLR) for CLAI has not been studied. Methods: Sixty-three ankles from 62 patients who received ALLR for CLAI were retrospectively examined. Preoperative plain radiographs were used to measure tibial articular surface (TAS) angles, and long axial hindfoot alignment radiographs were used to measure tibiocalcaneal angles (TCAs) pre- and postoperatively. Results included ratings on the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and recurrent ankle instability (respraining of the operated ankle following surgery). Results: Recurrent ankle instability, defined as incidence of any new ankle sprain after surgery reported in the follow-up period, occurred in 13 ankles. The TAS angles of these patients were significantly low, and their preoperative TCA was significantly high. Multivariate analysis showed that preoperative TCA was an independent risk factor for recurrent ankle instability. The threshold values for preoperative TCA for recurrent instability were determined via the receiver operating characteristic curve analysis to be 3.4 degrees. Patients were assigned to a low- or high-TCA group based on the reported average TCA (2.7 degrees) of healthy patients. In the high-TCA group, recurrent instability was significantly more frequent, and the scores on the pain subscale of the postoperative SAFE-Q were significantly lower. Conclusion: Hindfoot varus alignment was associated with pooreroutcomes after ALLR. Level of Evidence: Level III, retrospective comparative study.

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“…Within sports-related injuries, supination ankle sprains with subsequent injury to the lateral ankle ligaments range among the most common musculoskeletal injuries, with a risk-profile dependent incidence of 2–58 per 1000 person years, accounting for 10–30% of all sports injuries [ 10 , 45 ]. A growing body of evidence demonstrates that a surgical repair of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) via the Broström procedure [ 1 ] and its modifications [ 13 , 24 , 35 ] reliably produces favorable outcomes in cases of recurrent/chronic instability [ 18 , 23 , 31 , 34 , 47 ].…”

Section: Introductionmentioning

confidence: 99%

High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability

Rupp

Degenhardt

Winkler

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft. Methods Twenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24–112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed. Results Patients reported a Karlsson score of 82.1 ± 17.5 (37–100), a FAOS score of 87.8 ± 8.4 (73–99), a median Tegner activity scale of 5.0 (IQR 4–6) and a VAS for pain of 0.5 ± 0.9 (0–4) at rest and of 2.0 ± 2.1 (0–7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0–24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed. Conclusion Good patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients’ expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory. Level of evidence IV.

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Clinical Outcomes of Open Versus Arthroscopic Broström Procedure for Lateral Ankle Instability: A Meta-analysis

Cited by 34 publications

References 34 publications

Impact of Patient Resilience on Outcomes of Open Brostrom-Gould Lateral Ligament Repair

Impact of Patient Resilience on Outcomes of Open Brostrom-Gould Lateral Ligament Repair

Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair

High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability

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