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Broström ankle ligament repair augmented with suture tape

Results of magnetic resonance imaging evaluation

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Summary

Background

The Broström procedure is an established procedure in cases of primary lateral ankle ligament repair (LALR). To improve postoperative stability an augmentation device, InternalBrace™ (Arthrex, Naples, FL) has been introduced. This study evaluates remodelling of the anterior talofibular ligament (ATFL) in patients undergoing a tape augmented Broström technique as well as clinical outcomes.

Methods

In this study 32 patients with chronic lateral ankle instability (CLAI) receiving augmented LALR were included. Clinical outcomes were evaluated at a one-time postoperative visit between 12 and 18 months. A 3 T magnetic resonance imaging (MRI) was done to evaluate the morphology of the ATFL. Statistical analysis was completed with the free software and environment R version 3.6.3 (Bell Laboratories, Murray Hill, NJ, USA) and P-values < 0.05 were considered statistically significant.

Results

The mean follow-up time was 15.3 ± 1.8 months with a return to sport time of 4.0 ± 2.4 months. The average AOFAS (American Orthopaedic Foot and Ankle Society Score) score was 94.4 ± 7.2, the FAOS (Foot and Ankle Outcome Score) demonstrated 87.3 ± 10.4 points and the FFI (Foot Function Index – 2 scores (pain and function score)) was 22.9 ± 20.1 and 15.4 ± 10.4, respectively.

The MRI findings demonstrated an average length of the ATFL of 18.6 ± 4.3 mm and the width was 3.6 ± 0.9 mm. A clear differentiation between the ATFL and the augmentation device could be shown in 28 cases. The Fisher’s exact test could not depict a significant correlation between the presence of a bone marrow edema and the tension of the augmentation device with a level of significance of α = 0.05.

Conclusion

An anatomical healing tendency of the ligament repair and good integrity of the augmentation device could be shown based on MRI findings. The lateral ligament repair augmented with suture tape is an effective and safe procedure regarding surgical treatment in chronic lateral ankle instability producing good clinical outcome.

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Authors and Affiliations

  1. Department of Paediatric Orthopaedics and Adult Foot and Ankle Surgery, Orthopaedic Hospital Speising, Speisinger Straße 109, 1130, Vienna, Austria

    Florian Wenzel-Schwarz M.D., Elena Nemecek M.D., PhD &  Rudolf Ganger M.D., P.D.

  2. Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria

    Ulrike Wittig M.D.

  3. Department of Radiology, Orthopaedic Hospital Speising, Speisinger Straße 109, 1130, Vienna, Austria

    Till Bader M.D., M.Sc., P.D.

  4. Karl Landsteiner Institute for Clinical Risk Management, Hospital Hietzing, Wolkersbergenstraße 1, 1130, Vienna, Austria

    Wolfgang Huf M.D., B.Sc., M.Sc.

  5. Evangelical Hospital Vienna, Hans-Sachs-Gasse 10–12, 1180, Vienna, Austria

    Reinhard Schuh M.D., P.D., PhD

Authors
  1. Florian Wenzel-Schwarz M.D.
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  2. Ulrike Wittig M.D.
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  3. Elena Nemecek M.D., PhD
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  5. Till Bader M.D., M.Sc., P.D.
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  6. Wolfgang Huf M.D., B.Sc., M.Sc.
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  7. Reinhard Schuh M.D., P.D., PhD
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Corresponding author

Correspondence to Elena Nemecek M.D., PhD.

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Conflict of interest

F. Wenzel-Schwarz, U. Wittig, E. Nemecek, R. Ganger, T. Bader, W. Huf and R. Schuh declare the following potential conflict of interest: financial support for conducting MRI investigation during the research for this study by Arthrex.

Ethical standards

Ethical approval for this study was obtained from the ethics committee of the Wiener Krankenhäuser der Vinzenz Gruppe, Gumpendorferstraße 108, 1060 Vienna; approval number EK04/2018.

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Level of evidence IV

First author: Wenzel-Schwarz F.

Senior author: Schuh R.

Appendix

Appendix

Table 3 Rehabilitation protocol
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Wenzel-Schwarz, F., Wittig, U., Nemecek, E. et al. Broström ankle ligament repair augmented with suture tape. Wien Klin Wochenschr (2024). https://doi.org/10.1007/s00508-024-02361-1

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