Broström procedure

The Broström operation is a repair of damaged ligaments on the outer ("lateral") side of the ankle. It is designed to address ankle instability. More importantly, it is primarily used to repair the ATFL (anterior talofibular ligament) in the ankle. It has been shown that 85-90% of patients have gained full function to their ankle. The recovery time for the procedure varies on the patient but usually takes 3–6 months for full recovery. ^[1]

Purpose

The purpose of this procedure is to stabilize the ankle, improve the ankle's mechanics and restore full function. This procedure also aims to help a patient reduce pain related to their injury and ankle sprains, as well as to avoid early arthritis. Many patients who have this procedure will also notice that they experience ankle sprains far less often. Some patients will experience no ankle sprains after this procedure unless they experience a trauma to their ankle.

Description

During a Brostrom procedure the patient will be put to sleep under general anaesthesia. Once asleep the surgeon will thoroughly clean the area that will be operated on. They will then make all necessary incisions. Once the incisions are made they will repair any damaged lateral ankle ligaments in the hope of restoring the ankle back to its pre-injury state. This procedure can also include shortening and reattaching the lateral ligaments to reconstruct them. Once all of the repairs are made the surgeon will suture the incisions and apply any necessary bandages. Sports Medicine Surgeons will also take care of any side pathologies.

Surgical Technique: (http://www.wheelessonline.com/ortho/modified_brostrom_procedure)^[2] Incision is made over border of lateral malleolus; peroneal tendon exploration would require a posterolateral longitudinal incision; Surgeons care for peroneal tendons, sural nerve and lesser saphenous vein (which might be ligated), and branches of the superficial peroneal nerve; Proceeding thru subcutaneous tissue, identify and preserve the inferior extensor retinaculum; - this is mobilized for later attachment to the anterior edge of the fibula; - identify the ATFL,if it is torn, it is usually torn from the fibula; - make anterior capsular incision, leaving a small cuff of tissue, identify the CFL at the inferior tip of the fibula;ankle is then placed in valgus and dorsiflexion, and the redundancy of the ligament is assessed; sutures are passed thru the proximal edges of the ATFL and CFL; drill holes are made in the distal fibula; sutures are passed thru the drill holes, and are tied; the posterior edge of the extensor retinaculum is then opposed to the anterior edge of the fibula;

Post op care: - Standard involves 6 weeks of casting, but there is some evidence that there are better functional results with 3 weeks of casting.

^[3][4][5][6]

Possible Complications

Since this is a surgical procedure complications can occur. However, complications are generally rare. Some patients may experience an infection at the incision site. If an infection occurs, they can almost always be cured with a course of oral antibiotics. Another complication is superficial peroneal nerve distribution sensation reduction. Generalized ligaments laxity may also occur. Since anaesthesia is used there is a chance of anaesthesia complications including adverse reactions or allergic reactions.

Outcome

Those who have had this procedure done are expected to have a stronger ankle, meaning their ankle will no longer give out on them. It is estimated that approximately 85 percent of patients who have this procedure experience restored stability. Success can be achieved regardless of how soon the ankle is repaired after a patient's ankle instability issues occur, but the results are slightly better when the surgery is performed sooner. According to another study, approximately 91 percent of patients reported good to excellent results. Their ankles felt stable, and after they completely recovered, they noticed improved stability and significant restoration of function. Any pre existing arthritis stage in upper or lower ankle joints will not be changed through this procedure and may act as fact in decision making of pros and cons.

References

1. ↑ Bell S, Mologne T, Sitler D, Cox J (2006). "Twenty-six-year results after Broström procedure for chronic lateral ankle instability". The American journal of sports medicine 34 (6): 975–8. doi:10.1177/0363546505282616. PMID 16399935. 
2. ↑ Duke, Orthopaedics. "Wheeless' Textbook of Orthopaedics". Duke Orthopaedics. Retrieved 2 May 2013. 
3. ↑ "Sprained ankles." Brostrom, L. Acta Chir. Scand. Vol 132. 1966. p 551-565.
4. ↑ "The Modified Brostrom Procedure for Lateral Ankle Instability." W.G. Hamilton MD et al. Foot and Ankle. Vol. 14, No. 1/ Jan. 1993.
5. ↑ "Ankle Instability Repair: The Brostrom-Gould Procedure", W.G. Hamilton (Master Techniques in Orthopaedic Surgery. The Foot and Ankle.) Raven Press, Ltd. New York, 1994.
6. ↑ "Clinical Instability of the Modified Brostrom Evans Procedure to Restore Ankle Instability." P. Girard MD et al. Foot and Ankle Instability. Vol 20. No 4. Apr. 1999. p 246