Retrospective Chart Review of the Internal Brace Ligament Augmentation Repair in Conjunction with Open Broström Surgery in Ankle patients

Abstract

Category: Sports Introduction/Purpose: The Broström is the most commonly used Lateral ligament repair for chronic instability, but there is growing evidence that a fairly large percentage will stretch out with time, resulting in recurrent instability. Due to the nature of the repair, rehabilitation is also fairly slow, so not to compromise the tissue during the maturation stage. Currently, the Internal Brace Ligament Augmentation Repair is an accepted augmentation method for management of a Broström procedure. However, to our knowledge, no formally collected outcome data on the procedure has been reported. Hypotheses Augmentation of the Broström repair with an Internal Brace would 1)allow accelerated rehabilitation and return to activity, 2)Will aid in long-term stability of the repair without a tendency to stretch out. Methods: Patients with lateral ankle instability procedures repaired with a Broström and Internal Brace Augmentation were prospectively evaluated at one-time post-operative visit between 6 and 24 months. Patients with concomitant procedures other than debridement were excluded from the study. Outcome measures included demographics; surgical time; AOFAS, FAA, satisfaction, and VAS scores; ROM, Raise Test, and calf strength compared to the contralateral limb; return to sports, and adverse events. Fifteen patients were analyzed for the study from the two sites involved. The cohort includes 4 males and 11 females. 87% of patients were non-smoking cohort with an average BMI 29 ± 6 (range 22 to 44). Average age was 35.9 ± 12.1 years (20 to 56 years). Seven of the procedures were revisions. Furthermore, 60% of the injuries resulted from severe sprains to the involved ankle from normal ADL, while the rest are a result of a sport injury. The mean follow up time was 16.8 ± 6.8 months (range 6-24 months). Results: The complication rate was 7%. The average surgical time was 37 ± 10 minutes (range 20-53 minutes). The average postoperative VAS and Satisfaction scores were 1.5 ± 2.6 and 9.5 ± 1.6, respectively. The time to return to sports was 76 ± 22 days (range 48-122). The average AOFAS was 93.4 ± 10.3. Nine patients reported a 100 total score on the AOFAS. For the FAAM, 14 subjects reported from 90 to 100 on the ADL total score. Fourteen patients were brace free with activity. The objective calf strength examination (actual girth measured) proved not significantly different from the contralateral limb. (p=0.837). 75% of the cohort had a negative anterior drawer at their post op visit. Ankle dorsiflexion comparisons were 9.3 ± 3.0 cm (operative side) and 10.4 ± 3.2 cm (contralateral side); and ankle plantar flexion comparison (goniometer) 38 ± 7 degrees (operative side) and 37 ± 8 degrees (contralateral side). Neither comparison was statistically significant, p = .349 and p = .708, respectively. Conclusion: These results suggest the Internal Brace Augmentation of Broström procedure is safe and efficacious.