Results of an Accelerated Rehabilitation Program after Arthroscopic Broström Ankle Ligament Repair Augmented with an Arthroscopically Applied Suture Tape

Abstract

Category: Arthroscopy; Ankle; Sports Introduction/Purpose: The Broström-Gould is the gold standard in repair of the lateral ankle ligaments for chronic instability and arthroscopic Broström repairs have become increasingly popular with outcomes comparable to the open procedure. Despite demonstrated success, the arthroscopic Broström, like the open procedure, does not achieve the same mechanical strength as the intact native ankle ligaments and is therefore not appropriate for early aggressive rehabilitation. Suture tape augmentation of an open Broström procedure has been shown to further strengthen the repair and produce favorable outcomes in preventing recurrent instability. Studies reporting long-term clinical outcomes of patients who undergo this procedure are lacking. This study reports clinical and functional outcomes after an arthroscopic repair with arthroscopically applied suture tape augmentation and an accelerated post-operative rehabilitation protocol. Methods: Ninety-three patients with chronic recurrent ankle instability who had failed non-operative treatment (bracing, taping, physical therapy) underwent arthroscopic lateral ligament repair augmented by a suture tape applied in a novel all-arthroscopic fashion (double stranded polyethylene tape fixed to talus and fibula with interference screws). Postoperatively patients were placed in a CAM walker and allowed to bear weight immediately. On postoperative day 8 patients were placed in a functional brace and began physical therapy to include motion, strength, and proprioceptive activities. At week 4 patients began sports specific activities and were allowed to return to unrestricted activity at week 8. Foot and Ankle Ability Measure (FAAM), Visual Analog Score (VAS), Tegner Score, and range of motion measurements were performed. Statistical analysis was done to determine averages, ranges, and standard deviations of scores. Paired t-test was utilized to find statistically significant differences in scores. Results: Eighty-five patients (42 males, 43 females; average age 30.42 years) were available at a minimum of 24 months post- operatively (range 24-68). Postoperatively, average VAS scores fell to 0.85 from 4.67, (p<2.2e-16), average FAAM ADL scores rose from 69.44 to 93.09, (p<2.2e-16), average FAAM Sports scores rose from 49.76 to 89.61. (p<2.2e-16), average Ankle ROM scores decreased from 56.12o to 54.76o, (p=.001523) and average HF ROM decreased from 20.07o to 18.19o (p=1.225e-11). The average Tegner score postoperatively was 7.45 (4-10). Patients reported 75% excellent, 24% good, and 1% fair results. Average time to desired level of activity was 5.14 months. There were 5 complications: one wound dehiscence, 2 cases of anterolateral impingement, and two cases of superficial peroneal neuritis. There was no recurrent instability. Conclusion: The results indicate that acclerated rehabilitation after arthroscopic lateral ligament repair augmented with arthroscopically applied suture tape is a safe and effective procedure that produces favorable outcomes for patients with chronic recurrent ankle instability.