Effect of Internal Bracing on Broström Operation Clinical Outcomes

Abstract

Category: Ankle; Other Introduction/Purpose: When patients fail conservative management for chronic lateral ankle instability, a Broström procedure is often recommended. The purpose of this study was to investigate the postoperative trends between Broström recipients who were and were not augmented with suture tape, while secondarily assessing the relationship between demographics and medical history with postoperative outcomes for those patients. Methods: We conducted a retrospective review of 125 patients treated with a modified Broström by a single fellowship-trained foot and ankle surgeon at an academic medical center between 2016 and 2020. Overall, 39 patients received suture tape augmentation, 95 underwent a primary Broström and 30 a revision, and 24 were operated on with a nanoscope. Various demographics, medical history, patient-reported outcome measures (PROMs) (e.g., Foot and Ankle Outcome Score [FAOS], Foot and Ankle Ability Measure [FAAM]), and postoperative outcomes were collected. Average follow-up was 1.0 years (0.25-4.58). Results: There were no differences in any postoperative PROMs (i.e., FAOS, FAAM) between suture tape augmentation cohorts. Similarly, no difference existed in follow-up duration or complication rate. The only significant difference between cohorts pertained to the proportion of patients who underwent a reoperation specifically for incision and debridement (suture tape=71.4%, no suture tape=0.0%; p=.013). Furthermore, when analyzing the primary and revision Broström operation cohorts, there were no differences in any postoperative PROM, follow-up duration, or complication. Finally, when analyzing cohorts whose procedures did and did not use a nanoscope, there was no difference in any PROMs, complications, or reoperation rate, but follow-up duration was significantly longer for those whose procedures did not use a nanoscope (nanoscope=0.71 years, no nanoscope=1.13 years; p=.003). (Table 1) Conclusion: Neither suture tape augmentation or revision status was found to affect postoperative outcomes or PROMs for the Broström operation. However, unlike the control group, no patients who did not received suture tape augmentation underwent reoperation for deep infection, and these patients had a lower complication rate. The only variable that showed a difference in postoperative outcomes was whether a patient was concomitantly operated on with a nanoscope, in which their follow-up duration was reduced. Based on their overall predictiveness, preoperative PROMs may provide insight into clinical success following a Broström operation.