The precision of technical aspects in the minimally invasive Broström-Gould procedure：A Cadaveric Anatomical Study

Abstract

Background A comprehensive understanding of the anatomy of the anterolateral ankle joint and its interrelationships is essential for advancing the development of minimally invasive Brostrom-Gould procedure, thereby enhancing surgical efficacy and minimizing postoperative complications. Methods Ten fresh human ankle specimens were dissected to observe the shape and trajectory of the lateral bundle of the inferior extensor retinaculum（IER） and its relationship with the deep fascia. To observe the relationship between the ankle capsule and the anterior talofibular ligament（ATFL）. The center of the insertion point of ATFL at the lateral malleolus was used as the reference point.The vertical distance from the reference point to the fibula tip, the horizontal distance from the reference point to the lateral branch of the superficial peroneal nerve, the shortest distance from the reference point to IER，and the narrowest width of the IER were measured. The tension of ATFL was observed and measured. To describe the minimally invasive Broström-Gould procedure according to the anatomical characteristics of the anterolateral ankle joint. Results Among the 10 cases, 8 cases (80%) had double bundles of ATFL, 2 cases (20%) had single bundle of ATFL, and no outer superior oblique bundle was observed in IER. The vertical distance from the reference point to the fibula tip was 1.2±0.3(range 1.1-1.3)mm. The shortest distance from the reference point to the level of the superficial peroneal branch was 28.2±4.3(range 24.5-32.4)mm. The shortestdistance from the reference point to IER was 12.5±0.6(range 12.1-12.9)mm, and the width of IER at this point was 7.2±0.3(range 7.0-7.6)mm. The Angle between this point and the ATFL insertion and the fibula longitudinal axis was about 60°±2.8°(range 58.1°-62.1°)mm. The space between the anterolateral deep fascia of the ankle joint and the ankle capsule is very small, and only a few fat granules are separated between them. The ATFL is largely fused to the ankle capsule. Conclusions The results showed that in the minimally invasive Broström-Gould technique for lateral ankle stabilization, the Broström procedure actually sutured the insertion of the ATFL together with the ankle capsule to the anterior edge of the lateral malleolus. In the Gould procedure, the deep fascia was mostly reinforced with the ankle capsule. The maximum tension was obtained when the Gould suture needle direction was at an Angle of 60° to the longitudinal axis of the fibula.