2017 ISAKOS Biennial Congress ePoster #130

 

Clinical Results and Our Devises of Arthroscopic Brostrom Procedure With Suture Anchors for Lateral Ankle Instability

Noriyuki Kanzaki, MD, PhD, Kobe, Hyogo JAPAN
Kazuyuki Ibaraki, MD, Kobe, Hyogo JAPAN
Nobuaki Miyaji, MD, Kobe, Hyogo JAPAN
Toshikazu Tanaka, MD, Kobe JAPAN
Kyohei Nishida, MD, Pittsburgh, pennsylvania UNITED STATES
Daisuke Araki, MD, PhD, Kobe, Hyogo JAPAN
Takehiko Matsushita, MD, Kobe, Hyogo JAPAN
Ryosuke Kuroda, MD, PhD, Kobe, Hyogo JAPAN

Kobe University Graduate School of Medicine, Kobe, Hyogo, JAPAN

FDA Status Cleared

Summary

The arthroscopic Brostrom procedure has been described for anatomic repair of chronic lateral ankle instability, and the clinical results were reported to be good. And, the Gould procedure has been recommended to add the Brostrom procedure. We performed the Brostrom procedure almost never using Gould procedure and the clinical results were relatively good compared with past reports.

Abstract

Introduction

The arthroscopic Brostrom procedure with suture anchors has been described for anatomic repair of chronic lateral ankle instability, and the clinical results were reported to be good. However, there were variations of this technique. We performed this procedure with 3 portals and 2 suture anchors and we almost never used the inferior extensor retinaculum (Gould procedure). Now, we present our clinical results and introduce our technique.
Materials & Methods: Twenty cases in nineteen patients (12 males, 7 females) were examined. The mean age was 29.5 years (16 ~ 59) and the average period of postoperative monitoring was 10 months (6~ 16). The beginning of injury included 13 cases of ankle sprain during sports activity (4 cases of soccer, 3 cases of basketball, and others). Bilateral operation was performed only in 1 case.

Results

Additional procedure included 3 cases of Bone Marrow Stimulation (BMS) for osteochondral lesion of talus (OLT), 2 cases of hindfoot endoscopic resection for symptomatic os trigonum, and all cases of synovectomy of ankle joint. We used 3-portal technique (anteromedial or medial midline, anterolateral, and accessory anterolateral portal) and 2 suture anchors (10 hard anchors, 10 soft anchors). We usually use medial midline portal except for performing BMS for medial type OLT. The mean surgical time was 134 minutes (72 minutes~ 185 minutes). We almost never used Gould procedure that reinforces the repaired ligament using extensor retinaculum. Cast immobilization was performed for 3 weeks after the surgery. Anterior joint pain because of remaining osteophyte, Tinel sign of anterolateral portal, and back out of a suture anchor were seen one by one as postoperative complications. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale was improved from 73.4 points to 94.0 points, and there was no complication of restriction of ankle range of motion. Eleven out of 13 patients were able to return to their pre-injury level of sports activity.

Discussion

The arthroscopic Brostrom procedure with suture anchors has been described for anatomic repair of chronic lateral ankle instability and management of intra-articular lesions. This procedure in past reports had varieties of the number of portals and suture anchors, the material of suture anchors, and how to treat the inferior extensor retinaculum. We used 3-portal technique and 2 suture anchors the same as before. The arthroscopic Brostrom with Gould procedure has been reported to be a standard for treating lateral ankle instability. However, Gould procedure was not anatomical method, therefore we avoided to add this procedure. Alternatively, we passed the sutures through the lower part of lateral ligament complex as possible. The clinical results of arthroscopic Brostrom with Gould procedure were reported to be good, but our results were also relatively good. Therefore we suggested arthroscopic Brostrom alone is a reasonable method for treating lateral ankle instability. However, the number of patient was small and the follow-up period was short, therefore further investigation must be needed to identify the reasonable indication and limitation of this procedure and to refine this technique.