Immediate Weight Bearing after Modified-Brostrom Reconstruction: A Retrospective Review of an Accelerated Rehab Protocol

Abstract

Category: Ankle; Sports Introduction/Purpose: Majority of injuries to the anterior talofibular ligament (ATFL) will go on to heal with non-operative management. Nearly a third of these injuries, however, will go on to develop chronic pain and instability; in these cases, operative reconstruction is indicated. An anatomic modified Broström reconstruction has replaced a traditional tenodesis as the standard of care. This reconstruction is often limited by damage to the native tissue and the time required for ligamentous healing, restricting the benefits of early weight bearing. In order to maximize the benefits of early range-of-motion exercises and weight bearing while protecting the repair, a suture-tape augmented Broström procedure has been suggested. We hypothesized that a suture-tape augmented Broström procedure would allow early weightbearing while preventing early failure. Methods: A retrospective chart review of patients who underwent a suture-tape augmented Broström procedure from August, 2020 to January, 2023 was conducted. Our inclusion criteria consisted of MRI confirmation of ATFL injury, a positive anterior drawer, failure of non-operative management, and post-operative physical exam consisting of a single leg hop and single leg heel raise at six weeks. Patients who had concomitant cartilage injuries with allograft repair, posterior arthroscopic debridement, peroneal tendon repair, syndesmosis repair, or calcaneal osteotomies were excluded. All patients participated in our accelerated rehab protocol which included immediate post-operative weightbearing as tolerated (WBAT) in a boot for two weeks followed by WBAT in an ankle brace for four weeks. Physical therapy was initiated two weeks post-op. Our primary outcome was the ability of patients to perform a single leg hop and single leg heel rise at six weeks. Secondary outcomes included visual analog scores (VAS) and post-operative complications. Results: 128 patients met our inclusion criteria. Our mean follow up was 11 (range, 6-52) weeks. At 6 weeks postoperatively, 88 (90%) of the patients asked could perform a single-leg heel raise and 73 (80%) of the patients asked could perform a single-leg hop. The average VAS at the final follow up visit was 1.03+1.9 (range, 0-8). No patients required a revision surgery. Post-operative complications were peroneal or sural neuritis (6 patients) and persistent pain (4 patients). There was no difference in primary and secondary outcomes in patients who had concomitant cartilage injuries not treated with grafting. Male patients were more likely to be able to complete a single leg hop at 6 weeks postoperatively (p = .04). No difference was found amongst other demographic factors. Conclusion: This study demonstrated that a modified-Broström procedure with suture-tape augmentation allowed for immediate weight bearing without reconstruction failure. The vast majority of patients had an excellent functional outcome at six weeks post- operative with minimal complications being recorded. There were no cases of revision surgery, DVTs, post-operative infections, and no patients reported residual instability.