Outcomes Following Broström Repair with Internalbrace Ligament Augmentation vs Broström Repair Alone for the Treatment of Anterior Talofibular Ligament Injury of the Lateral Ankle

Abstract

Category: Ankle; Sports Introduction/Purpose: The Broström procedure is indicated for lateral ankle instability in the setting of acute or chronic ankle sprains, with injury of the anterior talofibular ligament (ATFL) being the most common. While the procedure is anatomically favorable, one disadvantage of the Broström procedure is significantly reduced strength of the repair when compared with the native ligament. Broström repair with augmentation of an InternalBrace (Arthrex, Naples, FL), nonabsorbable suture tape fixed directly to the bone, has demonstrated increased strength and stiffness of the repaired ATFL; however, there is a paucity of literature published on clinical outcomes. The purpose of this study is to compare clinical outcomes following treatment of ATFL injuries with Broström repair alone versus Broström repair with InternalBrace augmentation. Methods: Between January 2009 and December 2017, patients 18-75 years old who underwent surgical treatment for an ATFL injury of the lateral ankle injury with either a Broström repair alone (Cohort A) or Broström repair with InternalBrace augmentation (Cohort B) performed by two surgeons (TOC or CTH) and at least 2 years post-operative were identified. Minimum 2-year follow-up was obtained with patients completing subjective questionnaires including Foot and Ankle Ability Measure (FAAM) with Activities of Daily Living (ADL) and Sport subscales, Short Form-12 (SF-12) Mental Component Summary (MCS) and Physical Component Summary (PCS), Tegner activity scale, and patient satisfaction with surgical outcome. Demographics and patient-reported outcomes were compared between groups. Results: In total, 103 patients were included in the study. Cohort A had 54 patients (29 females) with median age of 32 (range: 19 to 68) and 49 of 54 patients (91%) completed follow-up at an median of 2.32 years (range: 2 to 12 years). Cohort B had 49 patients (29 females) with median age of 37 (range: 18 to 66) and 38 of 49 patients (78%) completed follow-up at an median of 3.07 years (range 2 to 7 years). There was no significant difference in age or sex between cohorts (p>0.05 for all). At earliest minimum 2-year follow-up, there was no significant difference in median post-operative FAAM ADL (97% vs 98%, p=0. 979), FAAM Sport (91% vs 91%, p=0.976), SF-12 PCS (56 vs 54, p=0.143), SF-12 MCS (56.6 vs 57.0, p=0.155), Tegner score (6 vs 5, p=0.214), or patient satisfaction (9 vs 9, p=0.781). Conclusion: Patients treated for ATFL injury of the lateral ankle with Broström repair with InternalBrace augmentation demonstrated similar clinical outcomes to those treated with Broström repair alone. With its advantages in strength and stiffness, the InternalBrace should be considered when treating lateral ankle instability in the setting of ligamentous injury since it allowed an earlier return to full weight bearing and a quicker rehabilitation protocol.