Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2010 Feb;45(1):16-23. Korean.
    Published online Feb 28, 2010.
    https://doi.org/10.4055/jkoa.2010.45.1.16
    Copyright © 2010 by The Korean Orthopaedic Association
    Original Article

    Outcomes of the Modified-Brostrom Procedure Using Suture Anchor for Chronic Lateral Ankle Instability: a Prospective, Randomized Comparison with the Bone Tunnel Technique

    Yong-Min Kim, M.D., Dong-Soo Kim, M.D., Eui-Sung Choi, M.D., Hyun-Chul Shon, M.D., Kyoung-Jin Park, M.D., Byung-Ki Cho, M.D., and Hyung-Joon Lee, M.D.
      • Department of Orthopaedic Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.
    • Correspondence to: Byung-Ki Cho, M.D. Department of Orthopaedic Surgery, Chungbuk National University Hospital, 62, Gaesin-dong, Cheongju 360-711, Korea. TEL: +82-43-269-6077, FAX: +82-43-274-8719, Email: titanick25@yahoo.co.kr
    Received September 04, 2009; Accepted December 09, 2009.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    This study was performed prospectively and randomly to compare the clinical outcomes of modified-Brostrom procedures using the suture anchor and the bone tunnel for chronic lateral ankle instability.

    Materials and Methods

    Thirty patients were followed up for more than 1 year after the modified-Brostrom procedures. Fifteen procedures treated with a suture anchor and 15 procedures treated with a bone tunnel technique assigned randomly were performed by a single surgeon. The clinical evaluation was performed according to the VAS for pain, the Karlsson scale and Sefton grading system. Measurements of the talar tilt and anterior talar translation was performed using anterior and varus stress radiographs.

    Results

    There were no significant differences in the pain VAS between the 2 techniques postoperatively. However, the pain VAS at postoperative 4th day was significantly higher in the bone tunnel group. The Karlsson scale had improved significantly from a preoperative average of 45.2 points to 90.1 points in the suture anchor group, and from 44.6 points to 88.3 points in the bone tunnel group. According to the Sefton grading system, 13 cases (86.7%) in the suture anchor group and 12 cases (80%) in the bone tunnel group achieved satisfactory results. The talar tilt angle and anterior talar translation had improved significantly from preoperative average of 14.2° and 6.2 mm to 6.4° and 4.5 mm in the suture anchor group, from 13.8° and 6.4 mm to 6.1° and 4.2 mm in the bone tunnel group. There were no significant differences between 2 techniques.

    Conclusion

    The techniques for ligament reattachment produced similar clinical and functional outcomes except for early-stage postoperative pain. Both modified-Brostrom procedures using the suture anchor and bone tunnel appear to be effective treatment methods for chronic lateral ankle instability. However, the suture anchor technique has an advantage of less early-stage postoperative pain.

    Keywords
    ankle; chronic lateral instability; modified-brostrom procedure; suture anchor; bone tunnel

    Figures

    Figure 1
    (A-B) Operative Photographs show reattachment of anterior talofibular and calcaneofibular ligaments using bone tunnel, and plication by periosteocapsular flap.

    Figure 2
    (A) Operative Photograph showing application of suture anchor into anatomic origin of anterior talofibular ligament. (B-C) The periosteocapsular flap created on the fibula is plicated over secured capsule(arrowhead) with the suture anchor. (D) The inferior extensor retinaculum was advanced and reattached to the periosteal flap.

    Figure 3
    (A, B) Postoperative stress radiographs show proper placement of suture anchor in fibula.

    Figure 4
    This graph shows progression and improvement of postoperative ankle pain. Significant differences in pain VAS were not found between 2 techniques except for postoperative 4th day.

    Tables

    Table 1
    Comparison between Bone Tunnel Group and Suture Anchor Group with Karlsson Scale (Mann-Whitney Test)

    Table 2
    Comparison between Bone Tunnel Group and Suture Anchor Group with Sefton Grading System (Fisher's Exact Test)

    Table 3
    Comparison between Bone Tunnel Group and Suture Anchor Group with Ankle Stress Radiographs (Mann-Whitney Test)

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    MeSH Terms
    Animals
    Ankle
    Humans
    Imidazoles
    Ligaments
    Nitro Compounds
    Pain, Postoperative
    Prospective Studies
    Suture Anchors
    Sutures
    Metrics
    Share
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    Tables
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