Simplified all-arthroscopic Broström technique in treatment of chronic lateral ankle instability in adolescents_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Xiancheng ¹ , YE Shufen ¹ ^{△共同第一作者} , ZHANG Xintao ² , LUO Yong ² , LI Jiatong ² , ZOU Mingyang ² ,  YOU Tian ²

1. School of Clinical Medicine, Shandong Second Medical University, Weifang Shangdong , 261071, P. R. China;
2. Department of Sports Medicine, Peking University Shenzhen Hospital, Shenzhen Guangdong , 518036, P. R. China;

Corresponding author：

YOU Tian, Email: 17914@163.com

Keywords：

Chronic lateral ankle instability; anterior talofibular ligament; arthroscopy; ligament repair; adolescent

DOI：

10.7507/1002-1892.202412093

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Objective To investigate effectiveness of simplified all-arthroscopic Broström technique in treatment of chronic lateral ankle instability in adolescents. Methods A clinical data of 21 adolescent patients with chronic lateral ankle instability, who met the selection criteria and were admitted between June 2023 and May 2024, was retrospectively analyzed. There were 18 males and 3 females with an average age of 16.0 years (range, 13-18 years). T There were 9 cases of left ankle joint injury and 12 cases of right ankle joint injury. Anterior talofibular ligament (ATFL) injury was diagnosed by arthroscopy in all patients. There were 11 cases of cartilage injury, 5 cases of avulsion fractures, and 6 cases of ankle impingement syndrome. The time from first sprain to operation ranged from 3-60 months (mean, 12 months). The ATFL was repaired and the ankle joint stability was restored by simplified all-arthroscopic Broström technique. Visual Analogue scale (VAS) score, Tegner score, American Orthopaedic Ankle Association (AOFAS) score, Karlsson ankle function scale (KAFS) score, Foot and Ankle Scale (FAOS) score were used to evaluate ankle pain and function. MRI were used to evaluate the ligament healing. Results All patients were followed up 8-15 months (mean, 12.6 months). After operation, 1 patient suffered from superficial peroneal nerve injury, 1 patient developed anterior scar impingement on the ankle, 2 patients had superficial wound infection, and 1 patient suffered from sprain again. The VAS score, Tenger score, AOFAS score, KAFS score, and FAOS score significantly improved when compared with the preoperative scores (P<0.05). MRI examination showed the ligament healing and good tension. Conclusion For adolescent patients with chronic lateral ankle instability, using simplified all-arthroscopic Broström technique to repair ATFL can effectively alleviate ankle pain, improve stability, and achieve good effectiveness.

1.	王震宇, 郑果, 郑小龙, 等. 部分腓骨短肌腱联合双 intra-fix 挤压螺钉固定解剖重建距腓前韧带. 中国修复重建外科杂志, 2021, 35(1): 70-75.
2.	Staats K, Sabeti-Aschraf M, Apprich S, et al. Preoperative MRI is helpful but not sufficient to detect associated lesions in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc, 2018, 26(7): 2103-2109.
3.	Zhang J, Yang K, Wang C, et al. Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 cases. J Sport Health Sci, 2023, 12(5): 606-612.
4.	Baumbach SF, Braunstein M, Herterich V, et al. Arthroscopic repair of chronic lateral ankle instability. Oper Orthop Traumatol, 2019, 31(3): 201-210.
5.	Vega J, Malagelada F, Manzanares Céspedes MC, et al. The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure. Knee Surg Sports Traumatol Arthrosc, 2020, 28(1): 8-17.
6.	Tonsuthanluck S, Handoyo HR, Tharincharoen R, et al. Comparative analyses of arthroscopic and open repairs of lateral ligament complex injuries of the ankle: a systematic review and meta-analysis of the medium-term outcomes. Eur J Orthop Surg Traumatol, 2024, 34(3): 1487-1495.
7.	Nakasa T, Ikuta Y, Sumii J, et al. Loosening of the anterolateral capsule affects the stability after arthroscopic lateral ankle ligament repair of chronic ankle instability. Arch Orthop Trauma Surg, 2024, 144(1): 189-196.
8.	Boutelle KE, Rickert KD, Carroll AN, et al. Intermediate-term outcomes in adolescent recurrent ankle instability managed with a modified broström-gould procedure augmented with distal fibular periosteum incorporation. J Pediatr Orthop, 2023, 43(3): e199-e203.
9.	Samejima Y, Inokuchi R, Iwashita K, et al. Arthroscopic ankle lateral ligament repair alone versus arthroscopic ankle lateral ligament repair with reinforcement by inferior extensor retinaculum. Arch Orthop Trauma Surg, 2021, 141(6): 987-995.
10.	Owoeye OBA, Whittaker JL, Toomey CM, et al. Health-related outcomes 3-15 years following ankle sprain injury in youth sport: what does the future hold? Foot Ankle Int, 2022, 43(1): 21-31.
11.	Adal SA, Mackey M, Pourkazemi F, et al. The relationship between pain and associated characteristics of chronic ankle instability: A retrospective study. J Sport Health Sci, 2020, 9(1): 96-101.
12.	Al Adal S, Pourkazemi F, Mackey M, et al. The prevalence of pain in people with chronic ankle instability: a systematic review. J Athl Train, 2019, 54(6): 662-670.
13.	Takao M, Inokuchi R, Jujo Y, et al. Clinical outcomes of concurrent surgery with weight bearing after modified lasso-loop stitch arthroscopic ankle stabilization. Knee Surg Sports Traumatol Arthrosc, 2021, 29(6): 2006-2014.
14.	易刚, 扶世杰, 杨静, 等. 全关节镜下与改良开放式Broström锚钉修复距腓前韧带的疗效比较. 中国修复重建外科杂志, 2019, 33(12): 1503-1509.
15.	Takao M, Jujo Y, Iwashita K, et al. Arthroscopic modified lasso-loop stitch technique for chronic lateral ankle instability in skeletally immature vs mature patients. Foot Ankle Int, 2024, 45(4): 373-382.
16.	Wittig U, Hohenberger G, Ornig M, et al. Improved outcome and earlier return to activity after suture tape augmentation versus broström repair for chronic lateral ankle instability? A systematic review. Arthroscopy, 2022, 38(2): 597-608.
17.	Scardua LC, da Silva Baptista J. Description of the lateral fibulotalocalcaneal ligament in fetal specimens and its potential clinical implications. Surg Radiol Anat, 2024, 46(2): 235-239.
18.	Hong CC, Lee JC, Tsuchida A, et al. Individual fascicles of the ankle lateral ligaments and the lateral fibulotalocalcaneal ligament complex can be identified on 3D volumetric MRI. Knee Surg Sports Traumatol Arthrosc, 2023, 31(6): 2192-2198.

1. 王震宇, 郑果, 郑小龙, 等. 部分腓骨短肌腱联合双 intra-fix 挤压螺钉固定解剖重建距腓前韧带. 中国修复重建外科杂志, 2021, 35(1): 70-75.
2. Staats K, Sabeti-Aschraf M, Apprich S, et al. Preoperative MRI is helpful but not sufficient to detect associated lesions in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc, 2018, 26(7): 2103-2109.
3. Zhang J, Yang K, Wang C, et al. Risk factors for chronic ankle instability after first episode of lateral ankle sprain: A retrospective analysis of 362 cases. J Sport Health Sci, 2023, 12(5): 606-612.
4. Baumbach SF, Braunstein M, Herterich V, et al. Arthroscopic repair of chronic lateral ankle instability. Oper Orthop Traumatol, 2019, 31(3): 201-210.
5. Vega J, Malagelada F, Manzanares Céspedes MC, et al. The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure. Knee Surg Sports Traumatol Arthrosc, 2020, 28(1): 8-17.
6. Tonsuthanluck S, Handoyo HR, Tharincharoen R, et al. Comparative analyses of arthroscopic and open repairs of lateral ligament complex injuries of the ankle: a systematic review and meta-analysis of the medium-term outcomes. Eur J Orthop Surg Traumatol, 2024, 34(3): 1487-1495.
7. Nakasa T, Ikuta Y, Sumii J, et al. Loosening of the anterolateral capsule affects the stability after arthroscopic lateral ankle ligament repair of chronic ankle instability. Arch Orthop Trauma Surg, 2024, 144(1): 189-196.
8. Boutelle KE, Rickert KD, Carroll AN, et al. Intermediate-term outcomes in adolescent recurrent ankle instability managed with a modified broström-gould procedure augmented with distal fibular periosteum incorporation. J Pediatr Orthop, 2023, 43(3): e199-e203.
9. Samejima Y, Inokuchi R, Iwashita K, et al. Arthroscopic ankle lateral ligament repair alone versus arthroscopic ankle lateral ligament repair with reinforcement by inferior extensor retinaculum. Arch Orthop Trauma Surg, 2021, 141(6): 987-995.
10. Owoeye OBA, Whittaker JL, Toomey CM, et al. Health-related outcomes 3-15 years following ankle sprain injury in youth sport: what does the future hold? Foot Ankle Int, 2022, 43(1): 21-31.
11. Adal SA, Mackey M, Pourkazemi F, et al. The relationship between pain and associated characteristics of chronic ankle instability: A retrospective study. J Sport Health Sci, 2020, 9(1): 96-101.
12. Al Adal S, Pourkazemi F, Mackey M, et al. The prevalence of pain in people with chronic ankle instability: a systematic review. J Athl Train, 2019, 54(6): 662-670.
13. Takao M, Inokuchi R, Jujo Y, et al. Clinical outcomes of concurrent surgery with weight bearing after modified lasso-loop stitch arthroscopic ankle stabilization. Knee Surg Sports Traumatol Arthrosc, 2021, 29(6): 2006-2014.
14. 易刚, 扶世杰, 杨静, 等. 全关节镜下与改良开放式Broström锚钉修复距腓前韧带的疗效比较. 中国修复重建外科杂志, 2019, 33(12): 1503-1509.
15. Takao M, Jujo Y, Iwashita K, et al. Arthroscopic modified lasso-loop stitch technique for chronic lateral ankle instability in skeletally immature vs mature patients. Foot Ankle Int, 2024, 45(4): 373-382.
16. Wittig U, Hohenberger G, Ornig M, et al. Improved outcome and earlier return to activity after suture tape augmentation versus broström repair for chronic lateral ankle instability? A systematic review. Arthroscopy, 2022, 38(2): 597-608.
17. Scardua LC, da Silva Baptista J. Description of the lateral fibulotalocalcaneal ligament in fetal specimens and its potential clinical implications. Surg Radiol Anat, 2024, 46(2): 235-239.
18. Hong CC, Lee JC, Tsuchida A, et al. Individual fascicles of the ankle lateral ligaments and the lateral fibulotalocalcaneal ligament complex can be identified on 3D volumetric MRI. Knee Surg Sports Traumatol Arthrosc, 2023, 31(6): 2192-2198.

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