Skip to main content

Advertisement

SpringerLink
Log in

Biomechanical evaluation against calcaneofibular ligament repair in the Brostrom procedure: a cadaveric study

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

Abstract

The modified Brostrom procedure is commonly recommended for reconstruction of the anterior talofibular ligament (ATF) and calcaneofibular ligament (CF) with an advancement of the inferior retinaculum. However, some surgeons perform the modified Bostrom procedure with an semi-single ATF ligament reconstruction and advancement of the inferior retinaculum for simplicity. This study evaluated the initial stability of the modified Brostrom procedure and compared a two ligaments (ATF + CF) reconstruction group with a semi-single ligament (ATF) reconstruction group. Sixteen paired fresh frozen cadaveric ankle joints were used in this study. The ankle joint laxity was measured on the plane radiographs with 150 N anterior drawer force and 150 N varus stress force. The anterior displacement distances and varus tilt angles were measured before and after cutting the ATF and CF ligaments. A two ligaments (ATF + CF) reconstruction with an advancement of the inferior retinaculum was performed on eight left cadaveric ankles, and an semi-single ligament (ATF) reconstruction with an advancement of the inferior retinaculum was performed on eight right cadaveric ankles. The ankle instability was rechecked after surgery. The decreases in instability of the ankle after surgery were measured and the difference in the decrease was compared using a Mann–Whitney U test. The mean decreases in anterior displacement were 3.4 and 4.0 mm in the two ligaments reconstruction and semi-single ligament reconstruction groups, respectively. There was no significant difference between the two groups (P = 0.489). The mean decreases in the varus tilt angle in the two ligaments reconstruction and semi-single ligament reconstruction groups were 12.6° and 12.2°, respectively. There was no significant difference between the two groups (P = 0.399). In this cadaveric study, a substantial level of initial stability can be obtained using an anatomical reconstruction of the anterior talofibular ligament only and reinforcement with the inferior retinaculum. The modified Brostrom procedure with a semi-single ligament (Anterior talofibular ligament) reconstruction with an advancement of the inferior retinaculum can provide as much initial stability as the two ligaments (Anterior talofibular ligament and calcaneofibular ligament) reconstruction procedure.

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

Similar content being viewed by others

References

  1. Brostrom L (1966) Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir Scand 132:551–565

    PubMed  CAS  Google Scholar 

  2. Chrisman OD, Snook GA (1969) Reconstruction of lateral ligament tears of the ankle. An experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure. J Bone Joint Surg Am 51:904–912

    PubMed  CAS  Google Scholar 

  3. Colville MR (1995) Reconstruction of the lateral ankle ligaments. Instr Course Lect 44:341–348

    PubMed  CAS  Google Scholar 

  4. De Vries J, Struijs PA, Raaymakers EL, Marti RK (2005) Long-term results of the Weber operation for chronic ankle instability: 37 patients followed for 20–30 years. Acta Orthop 76:891–898

    Article  PubMed  Google Scholar 

  5. Gould N, Seligson D, Gassman J (1980) Early and late repair of lateral ligament of the ankle. Foot Ankle 1:84–89

    PubMed  CAS  Google Scholar 

  6. Horibe S, Shino K, Taga I, Inoue M, Ono K (1991) Reconstruction of lateral ligaments of the ankle with allogeneic tendon grafts. J Bone Joint Surg Br 73:802–805

    PubMed  CAS  Google Scholar 

  7. Karlsson J, Bergsten T, Lansinger O, Peterson L (1988) Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am 70:581–588

    PubMed  CAS  Google Scholar 

  8. Karlsson J, Bergsten T, Lansinger O, Peterson L (1989) Surgical treatment of chronic lateral instability of the ankle joint A new procedure. Am J Sports Med 17:268–273 Discussion 273–264

    Article  PubMed  CAS  Google Scholar 

  9. Karlsson J, Lansinger O (1993) Chronic lateral instability of the ankle in athletes. Sports Med 16:355–365

    Article  PubMed  CAS  Google Scholar 

  10. Kjaersgaard-Andersen P, Wethelund JO, Nielsen S (1987) Lateral talocalcaneal instability following section of the calcaneofibular ligament: a kinesiologic study. Foot Ankle 7:355–361

    PubMed  CAS  Google Scholar 

  11. Krips R, Brandsson S, Swensson C, van Dijk CN, Karlsson J (2002) Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle Clinical and radiological findings after follow-up for 15 to 30 years. J Bone Joint Surg Br 84:232–236

    Article  PubMed  CAS  Google Scholar 

  12. Leach RE, Namiki O, Paul GR, Stockel J (1981) Secondary reconstruction of the lateral ligaments of the ankle. Clin Orthop Relat Res, pp 201–211

  13. Lee K, Yang K, Bae S, Suh T (2002) Modified brostrom procedure without calcaneofibular ligament reconstruction for chronic ankle instability. J Kor Sports Med 20:209–214

    Article  Google Scholar 

  14. Messer TM, Cummins CA, Ahn J, Kelikian AS (2000) Outcome of the modified Brostrom procedure for chronic lateral ankle instability using suture anchors. Foot Ankle Int 21:996–1003

    PubMed  CAS  Google Scholar 

  15. Okuda R, Kinoshita M, Morikawa J, Jotoku T, Abe M (1999) Reconstruction for chronic lateral ankle instability using the palmaris longus tendon: is reconstruction of the calcaneofibular ligament necessary? Foot Ankle Int 20:714–720

    PubMed  CAS  Google Scholar 

  16. Sammarco GJ, Idusuyi OB (1999) Reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft. Foot Ankle Int 20:97–103

    PubMed  CAS  Google Scholar 

  17. Sefton GK, George J, Fitton JM, McMullen H (1979) Reconstruction of the anterior talofibular ligament for the treatment of the unstable ankle. J Bone Joint Surg Br 61-B:352–354

    PubMed  CAS  Google Scholar 

  18. Tohyama H, Beynnon BD, Pope MH, Haugh LD, Renstrom PA (1997) Laxity and flexibility of the ankle following reconstruction with the Chrisman-Snook procedure. J Orthop Res 15:707–711

    Article  PubMed  CAS  Google Scholar 

  19. Weber BG, Humfauer W (1969) Zur Behandlung der frischen fibularen Bandruptur und der chronische fibularen Bandinsuffizienz. Arch Orthop Unfallchir 65:251–257

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Korea University School of Medicine, Ansan Hospital, 516 Gojan-dong, Danwon-gu, Ansan-si, Gyeonggi-do, 425-707, South Korea

    Jung Il Lee & Joon Ho Wang

  2. Department of Foot and Ankle Surgery, Eulji University School of Medicine, Seoul, South Korea

    Kyung-Tai Lee, J-Young Kim & Eung Soo Kim

  3. Department of Orthopedic Surgery, Sungkyunkwan University, Seoul, South Korea

    Ki Sun Sung

  4. Department of Physical Medicine and Rehabilitation, Korea University, Seoul, South Korea

    Sang-Heon Lee

Authors
  1. Kyung-Tai Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jung Il Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ki Sun Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J-Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eung Soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sang-Heon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joon Ho Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joon Ho Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, KT., Lee, J.I., Sung, K.S. et al. Biomechanical evaluation against calcaneofibular ligament repair in the Brostrom procedure: a cadaveric study. Knee Surg Sports Traumatol Arthr 16, 781–786 (2008). https://doi.org/10.1007/s00167-008-0557-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-008-0557-3

Keywords

Search

Navigation