Published online Feb 28, 2007.
https://doi.org/10.4055/jkoa.2007.42.1.91
Treatment of Chronic Ankle Lateral Instability using Modified Brostrom Procedure
Abstract
Purpose
To analyze the results of modified Brostrom procedure for chronic ankle lateral instability.
Materials and Methods
Twenty six patients were followed up for more than 1 year after performing the modified Brostrom procedure. The mean age was 35.3 years, and the mean follow-up period was 2.4 years. Anterior and varus stress radiographs were taken in all cases, and a preoperative MRI was taken in 22 cases. Clinically, the Karlsson scale and Sefton grading were used. The effects of age, injury pattern and associated injury such as osteochondral fracture on the clinical results were analyzed.
Results
Radiologically the difference in anterior displacement between the affected side and contralateral side was 3.1 mm, and that of the varus tilt was 4.2°. At the last follow-up, the Karlsson scale had increased from preoperative 47.5 points to 90.3 points. There were 14 excellent, 8 good, 3 fair and 1 poor results according to the Sefton grading. The results were significantly worse in patients over 50 years of age. An osteochondral fracture or degenerative changes also lowered the level of patient satisfaction.
Conclusion
The modified Brostrom procedure appears to be a safe and highly satisfactory procedure. However, a more careful approach is needed for patients over 50 years of age or with associated degenerative changes.
Fig. 1
Intraoperative photograph showing a lax calcaneofibular ligament (held with forecps) and a large Os subfibulare (black arrow).
Fig. 2
Ankle stress radiograph of an 18 year-old female patient showing varus instability of the right ankle and Os subfibulare.
Table 1
Patients' Data
Table 2
Factors affecting the Postoperative Results
References
-
Anderson ME. Reconstruction of the lateral ligaments of the ankle using the plantaris tendon. J Bone Joint Surg Am 1985;67:930–934.
-
-
Brostrom L. Sprained ankles. VI. Surgical treatment of "chronic" ligament ruptures. Acta Chir Scand 1966;132:551–565.
-
-
Chrisman OD, Snook GA. 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 1969;51:904–912.
-
-
Davis MW. Bilateral talar osteochondritis dissecans with lax ankle ligaments. Report of a case. J Bone Joint Surg Am 1970;52:168–170.
-
-
Evans DL. Recurrent instability of the ankle; a method of surgical treatment. Proc R Soc Med 1953;46:343–344.
-
-
Girard P, Anderson RB, Davis WH, Isear JA, Kiebzak GM. Clinical evaluation of the modified Brostrom-Evans procedure to restore ankle stability. Foot Ankle Int 1999;20:246–252.
-
-
Harrington KD. Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. J Bone Joint Surg Am 1979;61:354–361.
-
-
Karlsson J, Bergsten T, Lansinger O, Peterson L. Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am 1988;70:581–588.
-
-
Lee KT, Yang KW, Bae SW, Lee JH. Analysis of affecting factors of modified Brostrom procedure in chronic ankle lateral instability. J Korean Soc Foot Surg 2002;6:66–72.
-
-
Sefton GK, George J, Fitton JM, McMullen H. Reconstruction of the anterior talofibular ligament for the treatment of the unstable ankle. J Bone Joint Surg Br 1979;61:352–354.
-
-
Snook GA, Chrisman OD, Wilson TC. Long-term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle. J Bone Joint Surg Am 1985;67:1–7.
-