SLR - December 2022 - Trenton Leo, DPM
Title: Arthroscopic modified Broström operation versus open reconstruction with local periosteal flap in chronic ankle instabilityReference: Mederake M, Hofmann UK, Ipach I. Arthroscopic modified Broström operation versus open reconstruction with local periosteal flap in chronic ankle instability. Arch Orthop Trauma Surg. 2022 Dec;142(12):3581-3588.
Level of Evidence: Level IV
Scientific Literature Review Reviewed By: Trenton Leo, DPM
Residency Program: Eastern Virginia Medical School, Norfolk, VA
Podiatric Relevance: Multiple procedures have been researched and published in literature to address the pathology of chronic lateral ankle instability. A prevalence of upwards of 1.1% in the general population and greater than 23% in high school and college athletes has been reported in the literature. A debilitating condition for both demographics, this article aims to project an innovative approach to expedite patients back to normal activity and/or sport by comparing the modified Broström repair (MBR) to an open reconstruction of the lateral ankle ligaments with a periosteal flap (RPF).
Methods: A 25 patient retrospective review was completed by three physicians with patients either undergoing a modified Broström repair (14 subjects) versus open reconstruction of the lateral ankle ligaments with a periosteal flap (11 subjects). All patients experienced lateral ankle ligament damage diagnosed via magnetic resonance imaging (MRI) and failed at least 3 months of conservative treatment. Arthroscopic repair was completed using the Arthrex® implant system using anteromedial and anterolateral portals. Two suture anchors were placed 5mm and 10mm proximal to the distal tip of the fibula with the inferior extensor retinaculum sewed to the periosteum. Full weight-bearing in an ankle orthosis took place at 4 weeks post-operatively. Return to sport was allowed after 3 months. The open repair was performed with two drill holes in the direction of the ATFL and CFL attachment after two periosteal flaps are raised from proximal to distal on the fibula. The periosteal flaps were brought through their respective drill hole and tied under tension. Full weight-bearing with an orthosis ensued at 8 weeks with return to sport taking place at 6 months. Results were analyzed using numeric scales and questionnaires including the numeric rating scale (NRS) for pain evaluation and AOFAS scores.
Results: Results concluded that the MBR group sustained a statistically significant reduction in pain compared to the RPF group at 3 months which was equivocal at 1 year. The RPF group ultimately had higher absolute post- operative AOFAS values associated with procedure outcomes at 3 months and 1 year than the MBO group.
However, these values were not deemed statistically significant. Additionally, the RPF group sustained 4 complications consisting of either nerve damage or wound complications, twice the amount of the MBR group which sustained 1 nerve injury and 1 suture granuloma. Concluding, both groups observed reduction in future supinatory trauma however, neither group significantly greater than the other.
Conclusions: This study concludes comparable results in functional outcomes between arthroscopic and open repair with periosteal flaps in treating lateral ankle stabilization procedures. Surely, the arthroscopic procedure comes with a steeper learning curve and decreased visualization. However, the advantages of faster recovery time along with a more prompt reduction in pain show promise in being applied to not only the general population, but also the athletic population in which a more expeditious return is often sought. With the two methods also showing no significant difference in terms of torque to failure, degrees to failure, and stiffness, the MBR appears to serve as the optimal option when feasible.