Surgical Options for Chronic Lateral Ankle Instability: How Has the Incidence of the Broström-Gould Procedure Evolved in the Past Decade?

Abstract

Category: Ankle; Trauma Introduction/Purpose: The past 50 years has seen significant development of surgical techniques aimed at treating chronic lateral ankle instability. Surgical procedures currently being performed can be classified as anatomic ligament reconstruction as well as nonanatomic, and more recently, anatomic repair by tenodesis. Anatomic reconstruction is successful at circumventing important shortcomings associated with nonanatomic repair such as impaired ankle kinematics and biomechanics. One variation of the anatomic repairs described in orthopedic literature demonstrating excellent long-term functional outcomes includes the Broström-Gould (BG) modification. However, there is no detailed depiction of the procedural incidence in recent years. We hypothesize that the incidence of this surgical technique has risen in the past decade. Methods: The Truven MarketScan database was queried to identify patients who underwent a BG procedure from January 2009 to December 2019 based on CPT coding. Population estimates from the US Census Bureau were used to calculate the annual incidence of the BG procedure. Volume and incidence were estimated for annual sums, gender, age subgroups, and four statistical geographical regions of the U.S. Results: In total, 160,457 BG procedures were identified in the database from 2009 to 2019. Annual volumes have increased by 89.9%, from 10,441 to 19,829 total procedures nationwide. Procedural incidence reported per 1,000,000 people increased by 76.6%, at 61.1 in 2019. Increased incidence was demonstrated in males and females ≤65 years, with the highest annual incidence found <55 years of age. Incidence stratified by region rose in the South, West, and Midwest regions of the United States by 81.7%, 75.4%, and 69.2%, respectively. Conclusion: The epidemiology of operative treatment for chronic lateral ankle instability has yet to be clarified in recent years. Our findings demonstrate that the annual volumes and incidence of the BG procedure has increased in the past 11 years. Growth in incidence was found in both sexes below the age of 65 years whereby the greatest annual incidence was found in ages below 55 years. Incidence significantly rose in all regions of the United States except for the Northeast. The insight provided by epidemiologic studies allows orthopedic surgeons to better adapt their practice to the current trends in the field.