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Accelerated return-to-sport after Brostrom-repair with fibre tape augmentation for chronic ankle instability. A prospective case series.
Author(s):
de Kort J. (Netherlands)
,
de Kort J. (Netherlands)
Affiliations:
Gilsing G.
,
Gilsing G.
Affiliations:
Oomen P.
,
Oomen P.
Affiliations:
van der Weegen W.
van der Weegen W.
Affiliations:
ESSKA Academy. de Kort J. 05/09/18; 209244; P01-1058 Topic: Open Surgery
Joris de Kort
Joris de Kort
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Abstract
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Objectives: Surgically treating chronic ankle instability (CAI) using Brostrom-repair, which is currently considered the "gold standard" technique, results in a prolonged time to return to physical activity. Postoperatively patients have to be immobilized for approximately 6 weeks to protect the initially weak repair. The ESSKA-AFAS ankle instability group therefore advices to start the return-to-sport phase only 3-4 months post-surgery. Protecting the repair using a surgically placed fibre tape should allow a more aggressive rehabilitation protocol and faster return to sports. Our study objective was to evaluate if this augmented repair results in faster return to sports without reoccurrence of ankle inversion trauma.

Methods: Prospective Institutional Review Board approved, single surgeon prospective case series of non-professional athletes (n=7; 5 male, 2 female; mean age 25.2 years; soccer n=4; running n=1; volleyball n=1; cycling n=1) with CAI. Surgical technique consisted of open Brostrom-repair augmented with a fibre tape over the anterior talofibular (n=5) and calcaneofibular ligament (n=2). No postoperative immobilisation was used with weight bearing as tolerated. Patients underwent supervised rehabilitation using a milestone driven protocol. Postoperative hop-tests were used to evaluate readiness for sport-specific rehabilitation. Descriptive statistics were used to summarize results.

Results: Mean follow up was 1 year (min-max: 0.5 -1.5). No patient had recurrent ankle inversion trauma. No cases of overtightening were observed. The six weeks postoperative symmetry index was 100.5% for 'triple hop', 98.6% for the 'side hop' and 103.6% for the 'figure of 8 hop' test. First return to sport was achieved by all athletes between 9-12 weeks with full return to sports including competition after a mean of 4 months (min: 2, max 6 months)

Conclusions: Augmented lateral ankle ligament repair without postoperative immobilisation and aggressive rehabilitation can be an important advancement in treating CAI. Our results indicate that the current ESSKA-AFAS consensus regarding return to sport might be too cautious in case of augmented repair.

Keywords:
Chronic ankle instability augmented repair
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