SLR - February 2023 - Eric Deig, DPM
Title: Functional results of modified Mason-Allen suture versus horizontal mattress suture in the arthroscopic Brostrom-Gould procedure for chronic ankle instabilityReference: Liu J, Chen M, Xu T, Tian Z, Xu L, Zhou Y. Functional results of modified Mason-Allen suture versus horizontal mattress suture in the arthroscopic Broström-Gould procedure for chronic ankle instability. J Orthop Surg Res. 2022 Oct 20;17(1):459.
Level of Evidence: Level III comparative study
Reviewed By: Eric Deig, DPM
Residency Program: Ascension St. Vincent Indianapolis, Indianapolis, IN
Podiatric Relevance: Research has shown that the arthroscopic Brostrom-Gould procedure is able to achieve the same functional outcomes as open Brostrom-Gould procedure. Repair through this method has been shown to be less invasive and allows for treatment of a concomitant intraarticular lesion. Biomechanical studies have found no significant difference in fixation strength between the open and arthroscopic assisted procedure. The modified Mason-Allen suture was originally used for hand surgery tendon suture, and is currently used for repair of rotator cuff tear, labrum of the shoulder joint, meniscus posterior root, and Achilles tendon repair. This study evaluated the functional outcomes of a one-anchor modified Mason-Allen suture and a two-anchor horizontal mattress suture for the treatment of chronic ankle instability in arthroscopic Brostrom-Gould.
Method: 64 patients with chronic ankle instability underwent arthroscopic Brostrom-Gould repair of the ATFL by the senior arthroscopist. Arthroscopic debridement and treatment of intraarticular lesions was performed as necessary for all patients. As for how the method of repair was chosen, patients were advised to have two-anchor horizontal mattress suture. Patients could choose modified Mason-Allen suture with one anchor in consideration of cost savings. Ultimately, 30 patients received one anchor modified Mason-Allen suture, and 34 patients received two-anchor horizontal mattress suture. Post-operatively all results were evaluated by foot and ankle surgeons who had no knowledge of the procedure. Operation time, length of hospital stay, surgical cost, complications, and exercise before recovery were recorded. Functional evaluation indexes included VAS, AOFAS, and KAFS.
Results: There was a statistically significant difference in operation time and surgical cost between the two groups with the modified Mason-Allen suture group having a shorter operation time and lower surgical cost. There was no statistically significant difference in VAS, AOFAS, KAFS and anterior drawer test between the two groups at 1 and 2 years. No significant difference in the rate of return to sport between the two groups.
Conclusion: One-anchor modified Mason Allen suture was comparable to that of two-anchor horizontal mattress suture in arthroscopic Brostrom-Gould at intermediate-term follow-up, with a shorter operative time and lower cost. There were a number of limitations with this study as biomechanical differences and postoperative proprioception recovery were not compared between the two groups. Additionally, patients had concomitant injuries that may have affected the results of the study. Further studies are needed to evaluate the long-term outcomes of this technique and compare it against other operative techniques.