Summary

This retrospective cohort study demonstrated similar patient-reported outcomes at furthest minimum 2-year follow-up between patients who underwent Broström repair with suture tape augmentation versus Broström repair alone for treatment of anterior talofibular ligament (ATFL) injuries.

Abstract

Introduction

The Broström procedure is indicated for lateral ankle instability in the setting of acute or chronic ankle sprains, with injury to the anterior talofibular ligament (ATFL) being the most common. While this procedure is anatomically favorable, one disadvantage is significantly reduced strength of the repair compared to the native ATFL. An augmented Broström repair with nonabsorbable suture tape, InternalBrace (Arthrex, Naples, FL), fixed directly to bone has demonstrated similar strength and stiffness to the native ATFL. However, there is a paucity of literature comparing clinical outcomes between the Broström repair and an augmented Broström repair with suture tape.

Purpose

To compare clinical outcomes following treatment of ATFL injuries with Broström repair alone versus Broström repair with suture tape 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 augmented Broström repair with suture tape (Cohort B) performed by two surgeons, and minimum 2 years post-operative period 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), Tegner activity scale, and patient satisfaction with surgical outcome. Demographics and patient-reported outcomes were compared between groups, and proportional odds ordinal logistic regression was utilized.

Results

In total, 104 patients were included in the study. Cohort A had 55 patients (29 females) with median age of 32 (range: 19 to 68) and 52 of 55 patients (95%) completed furthest follow-up at a median of 6 years (range: 2 to 12 years). Cohort B had 49 patients (25 females) with median age of 34 (range: 18 to 66) and 40 of 49 patients (82%) completed furthest follow-up at a median of 4.5 years (range 2 to 8 years). There was no significant difference in age, sex or baseline patient reported outcomes between cohorts (p>0.05 for all). At furthest minimum 2-year follow-up, there was no significant difference in median post-operative FAAM ADL (96% vs 98%, p=0.641), FAAM Sport (88% vs 92%, p=0.396), SF-12 PCS (55 vs 54, p=0.982), Tegner score (5 vs 5, p=0.683), or patient satisfaction (9 vs 9, p=0.938). There was significantly higher SF-12 MCS (55.7 vs 57.3, p=0.03) in Cohort B. There was no significant difference between cohorts when adjusting for age, sex, baseline FAAM ADL, and prior surgery (p=0.43). Patient age was a statistically significant independent predictor of postoperative FAAM ADL score (p=0.009) with increased age being associated with lower postoperative FAAM ADL.

Conclusion

Patients treated for ATFL injury of the lateral ankle with Broström repair with suture tape augmentation demonstrated similar clinical outcomes to those treated with Broström repair alone. With its advantages in strength and stiffness, the suture tape should be considered when treating lateral ankle instability in the setting of ligamentous injury since it allowed an earlier return to full weightbearing and a quicker rehabilitation protocol.