Traditional Modified Broström vs Suture Tape Ligament Augmentation
Robert Kulwin, MD, Troy S. Watson, MD, Ryan Rigby, DPM, FACFAS, J. Chris Coetzee, MD, and Anand Vora, MD
The modified Broström (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI). Recently, suture tape (ST) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be fully established. The purpose of this study was to determine if ST augmentation provides an advantage over the traditional MB.
Adult patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI. The primary outcome measure was time to return to preinjury level of activity (RTPAL). Secondary outcome measures included complications, ability to participate in an accelerated rehabilitation protocol (ARP), patient-reported outcomes (PROs), and visual analog pain scale (VAS). A total of 119 patients with CLAI were enrolled and randomized to the MB (59 patients) or ST (60 patients) treatment arm.
Average RTPAL was 17.5 weeks after MB and 13.3 weeks after ST (P < .001). At 26 weeks, 12.5% of patients in the MB group and 3.6% of patients in the ST group had not managed RTPAL (P = .14). The complication rate was 8.5% in the MB group vs 1.7% in the ST group (P = .12). Four patients in the MB group failed to complete the ARP vs 1 in the ST group (P = .144).
Results from this multicenter, prospective, randomized trial suggest that ST augmentation allows for earlier RTPAL than MB alone. ST augmentation may support successful accelerated rehabilitation and did not result in increased complications or morbidity.
Chronic lateral ankle instability is one of the most common issues seen by foot and ankle surgeons. Surgical treatment involves reconstructing the lateral ligaments, and the modified Broström has long been the gold standard surgical treatment. However, the tissue available for reconstruction is often suboptimal. It is from this problem that the interest in an augmented repair arose. One such method is the InternalBrace (Arthrex) suture tape.
An excellent but retrospective study using InternalBrace augmentation by Coetzee et al in 2018 (Coetzee JC, Ellington JK, Ronan JA, Stone RM. Functional results of open Broström ankle ligament repair augmented with a suture tape. Foot Ankle Int. 2018;39(3);304-310) demonstrated an average return to sport in 12 weeks, a significant improvement from the 4-6-month timeframe reported in the literature. It also introduced an accelerated rehabilitation protocol that was critical to getting athletes back to sport quickly.
Robert Kulwin, MD
Department of Orthopaedics and
The Christ Hospital