Effect of Periosteal Flap Augmentation on Outcomes of Modified Broström-Gould Procedure for Chronic Lateral Ankle Instability

Abstract

Background: Chronic lateral ankle instability is relatively common after ankle sprains. The modified Broström-Gould procedure (MBG) is the gold standard operative treatment but has a known failure rate of up to 10%, or even more in high-risk groups. Periosteal flap augmentation (PFA) has been proposed to strengthen the repair. This study aimed to compare the outcomes of MBG with and without PFA. Methods: A matched-pair study was performed based on prospectively collected registry data for all patients undergoing lateral ankle ligament reconstruction in a tertiary institution. Patients who underwent the MBG with PFA were matched in a 1:1 ratio with patients undergoing MBG alone, based on age, gender, and body mass index (BMI). Patients with generalized ligamentous laxity or obesity were excluded. Clinical outcome scores were compared preoperatively and 2 years postoperatively. A total of 48 patients were included in the study (24 in each group). The mean age was 24.1 years, mean BMI was 23.1, and all patients were male. The baseline demographics and clinical scores in both groups were similar. Results: At 2 years postoperatively, both groups demonstrated significantly improved AOFAS Ankle-Hindfoot scores ( P < .001), but there were no between-group differences in total AOFAS scores (PFA score 90, MBG score 88, P = .79). There were no recurrences of instability or revision surgeries. Conclusion: Routine PFA did not improve the outcomes of MBG for chronic lateral ankle instability in the absence of risk factors for failure. Further studies are warranted to determine if there is a long-term benefit for augmentation in this population. Level of Evidence: Level III, retrospective comparative study.