Modified Broström procedure plus ankle arthroscopy may be effective for ankle instability

Hua Y. Arthroscopy. 26(4):524-528. April 2010.

Chinese investigators found that a modified Broström procedure combined with ankle arthroscopy yielded satisfactory results for patients with chronic ankle instability and intra-articular symptoms.

Yinghui Hua, MD, of Huashan Hospital, Fudan University, Shanghai, China, and colleagues identified 85 consecutive patients who had chronic ankle instability; all patients had intra-articular symptoms. The study included 58 men (58 ankles) and 27 women (29 ankles). The patients had a mean age of 24.4 years.

The investigators performed ankle arthroscopy to treat any intra-articular lesions. They then performed a modified Broström procedure, which included shortening of the anterior talofibular ligament and/or calcaneofibular ligament, as well as extensor retinaculum augmentation, according to the abstract. The investigators noted all intra-articular lesions found during ankle arthroscopy. They recorded American Orthopaedic Foot and Ankle Society (AOFAS) scores before surgery and at follow-up.

Hua and colleagues found intra-articular lesions in 79 ankles. Overall, 75 ankles had synovitis and soft tissue impingement, 33 had chondral injuries, 23 had anterior tibial osteophytes, seven had loose bodies and six had distal tibiofibular syndesmosis injuries.

The investigators followed 79 patients (81 ankles) for a mean of 29 months. The mean preoperative AOFAS scores improved from 46.6 ± 8.1 to 86.5 ± 7.6 postoperatively.

“Accompanying chondral injuries were associated with poorer surgical outcomes,” the investigators wrote in their abstract. Patients without chondral lesions had significantly higher mean postoperative AOFAS scores than those with chondral lesions (89.76 ± 5.88 vs. 81.35 ± 7.18). Improvements in postoperative AOFAS scores were also significantly greater in patients without chondral injuries (42.28 ± 9.04 vs. 36.06 ± 11.85).

This is another confirmatory study that the incidence of intra-articular pathology in patients who have had significant ankle trauma is considerable. Most ankle instabilities are the result of twisting injuries that tear the ligaments as well as place a great deal of stress on the joint surfaces, leading to cartilage injury. Several studies have documented this incidence in association with ankle fractures.

The study highlights the need to consider evaluating the entire joint when patients present with both instability as well as other joint symptoms.

– Steven Douglas K. Ross, MD
Clinical professor of orthopedics
University of California/Irvine School of Medicine
Orange, Calif.