Skip to main content
SpringerLink
Log in

Arthroscopic ankle lateral ligament repair with biological augmentation gives excellent results in case of chronic ankle instability

  • ANKLE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The open “Broström-Gould” procedure has become the gold standard technique for the treatment of chronic ankle instability. Although arthroscopic techniques treating ankle instability have significantly evolved in the last years, no all arthroscopic Broström-Gould has been described. The aim of the study was to describe the all-arthroscopic Broström-Gould technique [anterior talofibular ligament (ATFL) repair with biological augmentation using the inferior extensor retinaculum (IER)], and to evaluate the clinical results in a group of patients.

Methods

Fifty-five patients with isolated lateral ankle instability were arthroscopically treated. Arthroscopic ATFL repair with biological augmentation was performed through a two-step procedure. First, the ligament is reattached through an arthroscopic procedure. Next, the ligament is augmented with the IER that is endoscopically grasped. Both the ligament repair and its augmentation with IER were performed with the help of an automatic suture passer and two soft anchors. Characteristics of the patients, and pre- and postoperatively AOFAS and Karlsson scores were recorded.

Results

The median preoperative AOFAS score increased from 74 (range 48–84) to 90 (range 63–100). According to the Karlsson score, the median preoperative average increased from 65 (range 42–82) to 95 (range 65–100). No major complications were reported. Only one case (1.8%) required a revision surgery at 23 months of follow-up.

Conclusion

The arthroscopic all-inside ATFL repair with biological augmentation using the IER is a reproducible technique. Excellent clinical results were obtained. The technique has the advantage of its minimally invasive approach and the potential to treat concomitant ankle intra-articular pathology.

Level of evidence

Retrospective case series, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Abu-Hijleh MF, Harris PF (2007) Deep fascia on the dorsum of the ankle and foot: extensor retinacula revisited. Clin Anat 20:186–195

    Article  Google Scholar 

  2. Acevedo JI, Mangone PG (2011) Arthroscopic lateral ankle ligament reconstruction. Tech Foot Ankle Surg 10:111–116

    Google Scholar 

  3. Aydogan U, Glisson RR, Nunley JA (2006) Extensor retinaculum augmentation reinforces anterior talofibular ligament repair. Clin Orthop Relat Res 442:210–215

    Article  Google Scholar 

  4. Barg A, Pagenstert GI, Hügle T, Gloyer M, Wiewiorski M, Henninger HB, Valderrabano V (2013) Ankle osteoarthritis: etiology, diagnostics, and classification. Foot Ankle Clin 18:411–426

    Article  Google Scholar 

  5. Behrens SB, Drakos M, Lee BJ, Paller D, Hoffman E, Koruprolu S, DiGiovanni CW (2013) Biomechanical analysis of Brostrom versus Broström-Gould lateral ankle instability repairs. Foot Ankle Int 34:587–592

    Article  Google Scholar 

  6. Brown AJ, Shimozono Y, Hurley ET, Kennedy JG (2018) Arthroscopic repair of lateral ankle ligament for chronic lateral ankle instability: a systematic review. Arthroscopy 34:2497–2503

    Article  Google Scholar 

  7. Cho B-K, Park K-J, Kim S-W, Lee H-J, Choi S-M (2015) Minimal invasive suture-tape augmentation for chronic ankle instability. Foot Ankle Int 36:1330–1338

    Article  Google Scholar 

  8. Coetzee JC, Ellington JK, Ronan JA, Stone RM (2018) Functional results of open Broström ankle ligament repair augmented with a suture tape. Foot Ankle Int 39:304–310

    Article  Google Scholar 

  9. Cottom JM, Baker JS, Richardson PE (2016) The “all-inside” arthroscopic Broström procedure with additional suture anchor augmentation: a prospective study of 45 consecutive patients. J Foot Ankle Surg 55:1223–1228

    Article  Google Scholar 

  10. Cottom JM, Rigby RB (2013) The “all inside” arthroscopic Broström procedure: a prospective study of 40 consecutive patients. J Foot Ankle Surg 52:568–574

    Article  Google Scholar 

  11. Dalmau-Pastor M, Malagelada F, Kerkhoffs GMMJ, Manzanares MC, Vega J (2018) X-shaped inferior extensor retinaculum and its doubtful use in the Broström-Gould procedure. Knee Surg Sports Traumatol Arthrosc 26:2171–2176

    Article  CAS  Google Scholar 

  12. Dalmau-Pastor M, Yasui Y, Calder JD, Karlsson J, Kerkhoffs GMMJ, Kennedy JG (2016) Anatomy of the inferior extensor retinaculum and its role in lateral ankle ligament reconstruction: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 24:957–962

    Article  CAS  Google Scholar 

  13. Ferkel RD, Scranton PEJ (1993) Arthroscopy of the ankle and foot. J Bone 75:1233–1242

    CAS  Google Scholar 

  14. Guillo S, Archbold P, Perera A, Bauer T, Sonnery-Cottet B (2014) Arthroscopic anatomic reconstruction of the lateral ligaments of the ankle with gracilis autograft. Arthrosc Tech 3:e593–598

    Article  Google Scholar 

  15. Hamilton WG, Thompson FM, Snow SW (1993) The modified Broström procedure for lateral ankle instability. Foot Ankle 14:1–7

    Article  CAS  Google Scholar 

  16. Jeong BO, Kim MS, Song WJ, SooHoo NF (2014) Feasibility and outcome of inferior extensor retinaculum reinforcement in modified Broström procedures. Foot Ankle Int 35:1137–1142

    Article  Google Scholar 

  17. Karlsson J, Peterson L (1991) Evaluation of ankle joint function: the use of a scoring scale. Foot 1:15–19

    Article  Google Scholar 

  18. Kim ES, Lee KT, Park JS, Lee YK (2011) Arthroscopic anterior talofibular ligament repair for chronic ankle instability with a suture anchor technique. Orthopedics 34(4):273

    Google Scholar 

  19. Matsui K, Takao M, Miyamoto W, Innami K, Matsushita T (2014) Arthroscopic Broström repair with Gould augmentation via an accessory anterolateral port for lateral instability of the ankle. Arch Orthop Trauma Surg 134:1461–1467

    Article  Google Scholar 

  20. Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N (2011) Arthroscopic-assisted Broström-Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med 39:2381–2388

    Article  Google Scholar 

  21. Nuno MC-R, Moreira RM (2009) Arthroscopic repair of chronic lateral ankle instability. Foot Ankle Int 30:213–217

    Article  Google Scholar 

  22. Paden MH, Stone PA, McGarry JJ (1994) Modified Broström lateral ankle stabilization utilizing an implantable anchoring system. J Foot Ankle Surg 33:617–622

    CAS  PubMed  Google Scholar 

  23. Parnes N, Blevins M, Morman M, Carey P (2016) The oblique mattress lasso-loop stitch for arthroscopic capsulolabral repair. Arthrosc Tech 5:e959–e963

    Article  Google Scholar 

  24. Pijnenburg AC, Van Dijk CN, Bossuyt PM, Marti RK (2000) Treatment of ruptures of the lateral ankle ligaments: a meta-analysis. J Bone Joint Surg Am 82:761–773

    Article  CAS  Google Scholar 

  25. Shahrulazua A, Ariff Sukimin MS, Tengku Muzaffar TM, Yusof MI (2010) Early functional outcome of a modified Broström-Gould surgery using bioabsorbable suture anchor for chronic lateral ankle instability. Singap Med J 51:235–241

    CAS  Google Scholar 

  26. Takao M, Glazebrook M, Stone J, Guillo S (2015) Ankle arthroscopic reconstruction of lateral ligaments (ankle anti-ROLL). Arthrosc Tech 4:e595–600

    Article  Google Scholar 

  27. Vega J, Dalmau-Pastor M, Malagelada F, Fargues-Polo B, Peña F (2017) Ankle arthroscopy: an update. J Bone Joint Surg Am 99:1395–1407

    Article  Google Scholar 

  28. Vega J, Golanó P, Pellegrino A, Rabat E, Peña F (2013) All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique. Foot Ankle Int 34:1701–1709

    Article  Google Scholar 

  29. Vega J, Malagelada F, Manzanares Céspedes M-C, Dalmau-Pastor M (2018) The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5188-8

    Article  PubMed  Google Scholar 

  30. Vega J, Montesinos E, Malagelada F, Baduell A, Guelfi M, Dalmau-Pastor M (2018) Arthroscopic all-inside anterior talo-fibular ligament repair with suture augmentation gives excellent results in case of poor ligament tissue remnant quality. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5117-x

    Article  PubMed  Google Scholar 

  31. Yoo J-S, Yang E-A (2016) Clinical results of an arthroscopic modified Broström operation with and without an internal brace. J Orthop Traumatol 17:353–360

    Article  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Clinique du Sport Bordeaux-Mérignac, Institut du Sport, 2 rue negrevergne, 33700, Merignac, France

    Guillaume Cordier

  2. Groupe de Recherche et d’Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France

    Guillaume Cordier, Johan Lebecque, Jordi Vega & Miki Dalmau-Pastor

  3. Groupe Hospitalier Pellegrin, Bordeaux, France

    Johan Lebecque

  4. Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), Laboratory of Arthroscopic and Surgical Anatomy, University of Barcelona, Barcelona, Spain

    Jordi Vega & Miki Dalmau-Pastor

  5. Foot and Ankle Unit, Hospital Quirón and Clinica Tres Torres, Barcelona, Barcelona, Spain

    Jordi Vega

  6. Vilamèdic, Santa Coloma de Gramanet, Barcelona, Spain

    Miki Dalmau-Pastor

Authors
  1. Guillaume Cordier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johan Lebecque
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jordi Vega
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miki Dalmau-Pastor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guillaume Cordier.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Ethics and Research Committee of Clinique du Sport, Bordeaux-Merignac, France approved the study (No. 09.2017.12.).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cordier, G., Lebecque, J., Vega, J. et al. Arthroscopic ankle lateral ligament repair with biological augmentation gives excellent results in case of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 28, 108–115 (2020). https://doi.org/10.1007/s00167-019-05650-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05650-9

Keywords

Search

Navigation