J Korean Orthop Assoc.  2018 Apr;53(2):103-111. 10.4055/jkoa.2018.53.2.103.

Arthroscopic Modified Broström Operation for Lateral Ankle Instability

• Lee YK
• Yeo ED
• Yoo J

• KMID: 2410057
• DOI: http://doi.org/10.4055/jkoa.2018.53.2.103

Abstract

Lateral ankle sprain is the most common ankle injuries. Patients who fail conservative treatments are candidates for modified Broström operation (MBO). Traditionally, the primary surgical treatment performed is the open MBO. Recently, there has been an evolution in the arthroscopic treatment of lateral ankle injury. Several reports reveal biomechanically equivalent results of arthroscopic vs . open MBO when using matched cadaver pairs. Also there was no difference in the clinical or radiologic outcomes between the arthroscopic and open MBO in randomized controlled trial. Therefore, arthroscopic MBO is reasonable and good alternative treatment for lateral ankle injury. Actually new techniques of arthroscopic treatment for ankle injury is introduced about arthroscopic syndesmotic repair and arthroscopic deltoid repair. Arthroscopic techniques for ankle injuries seem to develop further in the future.

Keyword

lateral ankle ligament injury; modified Broström operation; arthroscopy

MeSH Terms

Ankle Injuries
Ankle*
Arthroscopy
Cadaver
Humans

Figure

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  Figure 1 Hind foot and leg fixed with polyurethane with the ankle in 15° of internal rotation and 20° of plantarflexion. The hind foot was held statically in the mechanical testing device as the leg was rotated about its axis, creating an inversion force.

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  Figure 2 Operative procedure using the anchor suture technique. (A) A far lateral portal was made over the anterior fibula, and two accessory anteroinferior portals were made in sinus tarsi area. One end of the threads were passed through a far lateral portal. (B) The other end of thread was passed through the two accessory anteroinferior portals using the arthroscopic retriever. (C) The mosquitte was inserted through the far lateral portal to the accessory anteroinferior portals subcutaneously. (D) Then the threads on accessory anteroinferior portals were retrieved subcutaneously. (E) Then know was pastened using knot pusher with ankle dorsiflexed and everted.

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  Figure 3 These are schematic figures.

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  Figure 4 Bassett ligament (right ankle). T, tibia; F, fibula; L, talus; B, Bassett ligament.

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  Figure 5 This figure shows safe zone, which margin is composed of superior peroneal tendon margin, lateral cutaneous branch of superficial peroneal nerve, and distal part of sinus tarsi.

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  Figure 6 Schematic representation of the operation. (A) Rupture of anterior inferior tibio-fibular ligament (AITFL) (arrow) and intact posterior inferior tibiofibular ligament (arrowhead)–‘open book’ syndesmotic injury. (B) View of repaired AITFL with two anchors.

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  Figure 7 Arthroscopic photos during arthroscopic syndesmotic repair: (A) Predrilling to fix the Biocompositive Swivelock anchor; (B) fixing the Biocompositive SwiveLock on the anterior fibular surface immediately proximal to the Bassett's ligament insertion site; (C) fixed Tiger Tape Loop running between the distal tibia and fibula, above the Bassett's ligament. T, tibia; F, fibula; L, talus.

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  Figure 8 Arthroscopic photographs showing arthroscopic repair of deltoid: (A) Predrilling to fix the Bio-sutureTak (Arthrex) anchor; (B) the 4 strands of each suture pulled out in the distal portion of the anterior deltoid ligament between the tibialis anterior and posterior tendon; and (C) the stability of the anterior deltoid ligament is checked with a probe after each knot is tightened. T, tibia; F, fibula; L, talus.

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