SLR - May 2014 - Tonyka James
Reference: Wainright WB, Spritzer CE, Lee HY, Easley ME, DeOrio JK, Nunley JA, DeFrate LE. The Effect of Modified Brostrom-Gould Repair for Lateral Ankle Instability on the In Vivo Tibiotalar Kinematics. American Journal of Sports Medicine. September 2012: 40(9): 2099-104.
Scientific Literature Review
Reviewed By: Tonyka James, DPM
Residency Program: Medstar Washington Hospital Center
Podiatric Relevence: Chronic ankle instability alters kinematics attributing to tibiotialar joint degeneration. This study aims to evaluate the efficacy of the Brostrom-Gould repair to improve abnormal ankle motion in this subset of patients.
Methods: This was a controlled study comprised of seven patients all with diagnosed chronic lateral ankle instability as noted by patient complaint of ankle sprain treated nonoperatively for six months. Each patient underwent an MRI of both ankles to confirm lateral pathology. Patients with noted contralateral lesions, osteochondral defects, or peroneal dysfunction were excluded from the study. The anterior talofibular ligament was reconstructed, and the calcaneal fibular ligament as needed if pathology was noted on the MRI. Preoperatively, each patient underwent kinematic measurements where orthogonal imaging was performed biplanar and fluoroscopically. Total body weight was measured, then weightbearing views were performed anteriomedially/laterally. Images were taken with 25, 50, 75 and 100 percent bodyweight being placed on the ankle in neutral. All patients underwent the Brostrom-Gould procedure and had negative anterior drawer and talar tilt procedures before wound closure. Postoperatively (12 months) the same orthogonal fluoroscopic images were taken. Kinematics were measured with importation of the fluoroscopic images, and the MRI images such that six degrees of freedom were evaluated. Their measurements were focused on the anterior-posterior translation, and internal-external rotation of the talus relative to the tibia.
Results: This included seven patients (mean age of 37 years) with two patients having isolated anterior talofibular damage and five patients having both ATFL and CFL damage. Comparing anterior translation of the talus before and after repair, it is noted that there was a decrease in anterior translation postoperatively at 100 percent bodyweight. Also, this was noted to be within 0.0-0.3mm of translation of the contralateral ankle. Internal rotation of the talus was noted to be decreased after surgery at 75 percent and 100 percent bodyweight, and was noted to be within 0.7-2.0 degrees of rotation of the contralateral ankle.
Conclusion: This study presents data that the Brostrom-Gould procedure restores normal kinematics and may prevent long term degeneration of the ankle joint. This and other studies supporting the Brostrom-Gould procedure will encourage my usage in my future practice.