Arthroscopic Modified Broström Procedure for Chronic Ankle Instability

Shay Tenenbaum Nathan Brook Niv Dreiangel Oded Coifman
Department of orthopaedic surgery, Chaim Sheba Medical Center at Tel-Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel

Introduction: Lateral ankle sprains are very common sports injuries. Although most people recover without significant long-term sequelae, chronic ankle instability may develop in up to 20% of patients. For minority of patients who fail nonoperative regimens surgical reconstruction is indicated.
While open modified Brostrom procedure is accepted as the reference treatment standard, alternative techniques evolve. We present our preliminary results with the ArthroBrostrom procedure.

Materials and Methods: Nineteen patients had undergone arthroBrostrom procedure, with mean followup 6.8 months.
Data included demographics, concomitant procedures, complications and clinical results.

Results: Patients mean age was 22.3 years (range 18 to 38). Average surgery time was 67 minutes.
During arthroscopy, in 11/19 of cases significant synovitis was found, 5 cases of Bassett’s ligament causing anterolateral impingement, 1 case of a Ferkel lesion and 3 OLT. Concomitant procedures were performed in 5 cases (3 OLT, 1 peroneal exploration and Os trigonum excision). Postoperative complications included 3 nerve injuries (2 cases SPN irritation, 1 case mild CRPS) and 1 case of ankle arthrofibrosis. Out of 11 patients with followup time ≥4m, for which the postoperative physical activity status was available, 7 patients returned to preoperative physical activity. Overall, 2 cases had undergone secondary surgery, 1 case of arthrofibrosis treated with repeated arthroscopy, and 1 case of continued instability revised with allograft tendon reconstruction.

Conclusion: ArthroBrostrom procedure offers the ability to simultaneously address intra-articular pathologies apart from instability treatment, with less chance of wound complications. However, this procedure is not without complications, and a learning curve exists.