The augmentation technique for anatomical reduction of shortened lateral ligament complex in modified brostr��m procedure
ESSKA Academy. Kang C. 11/08/19; 285208; epAFAS-05 Topic: B2 - Open repair and reconstruction
Prof. Chan Kang
Prof. Chan Kang
Login now to access Regular content available to all registered users.

You can access free regular educational content on the ESSKA Academy by registering as an 'ESSKA Academy User’ here

Access to Premium content is currently a membership benefit.

Click here to join ESSKA or renew your membership.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Introduction: The modified Brostr��m procedure(MBP) is clinically standard surgical treatment of lateral ankle instability with or without subfibular ossicle. But if there is a large ossicle or distal malposition of lateral ligament complex(LLC), it can result in a lack of remnant ligamentous tissue and leave a gap that may not be approximated. Thus, we have proposed an augmentation technique for anatomical reduction of shortened LLC in MBP and evaluated the radiologic and clinical findings.
Material and methods: From December 2013 to February 2017, fifty two of fifty six patients (52 of 56 ankles) who had shortened LLC by ossicle or distal malposition of LLC treated with the augmentation technique with MBP using absorbable suture material were included in this study. Four patients who had too large LLC gap to approximate and underwent augmentation with internal brace were excluded. The mean follow-up duration was 2.4 years (range, 1.0-4.7 years). The operation was performed as follows in brief. The LLC(anterior talofibular ligament(ATFL) and calcaneofibular ligament(CFL)) was exposed after the inferior extensor retinaculum(IER) was incised. Then, we identified shortened LLC after the removal of ossicle or resection of the distally malpositional LLC from the fibula. Then, we incised the just distal part of connecting soft tissue of ATFL and CFL additionally for reduction to anatomic footprint.
The postoperative clinical evaluations were performed by American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson score. And the radiographic evaluations were done by talar tilt angle, and anterior talar translation.
Results: The mean AOFAS scores improved from 59.2 to 91.4 at final follow-up. The mean Karlsson scores also improved from 61.3 to 89.5 at final follow-up. There was significant improvement between preoperative & final follow-up in all parameters (all p < .05). During follow up, no clinical symptom like experience of instability or irritation of skin were encountered after surgery, and no patient underwent revision lateral ligament surgery.
Conclusion: The augmentation technique of LLC flap in MBP enabled anatomical reduction of shortened LLC to footprint, and provided good clinical and radiographic outcomes. If further comparative and mechanical study is supported, this technique would be a good treatment option.
Introduction: The modified Brostr��m procedure(MBP) is clinically standard surgical treatment of lateral ankle instability with or without subfibular ossicle. But if there is a large ossicle or distal malposition of lateral ligament complex(LLC), it can result in a lack of remnant ligamentous tissue and leave a gap that may not be approximated. Thus, we have proposed an augmentation technique for anatomical reduction of shortened LLC in MBP and evaluated the radiologic and clinical findings.
Material and methods: From December 2013 to February 2017, fifty two of fifty six patients (52 of 56 ankles) who had shortened LLC by ossicle or distal malposition of LLC treated with the augmentation technique with MBP using absorbable suture material were included in this study. Four patients who had too large LLC gap to approximate and underwent augmentation with internal brace were excluded. The mean follow-up duration was 2.4 years (range, 1.0-4.7 years). The operation was performed as follows in brief. The LLC(anterior talofibular ligament(ATFL) and calcaneofibular ligament(CFL)) was exposed after the inferior extensor retinaculum(IER) was incised. Then, we identified shortened LLC after the removal of ossicle or resection of the distally malpositional LLC from the fibula. Then, we incised the just distal part of connecting soft tissue of ATFL and CFL additionally for reduction to anatomic footprint.
The postoperative clinical evaluations were performed by American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson score. And the radiographic evaluations were done by talar tilt angle, and anterior talar translation.
Results: The mean AOFAS scores improved from 59.2 to 91.4 at final follow-up. The mean Karlsson scores also improved from 61.3 to 89.5 at final follow-up. There was significant improvement between preoperative & final follow-up in all parameters (all p < .05). During follow up, no clinical symptom like experience of instability or irritation of skin were encountered after surgery, and no patient underwent revision lateral ligament surgery.
Conclusion: The augmentation technique of LLC flap in MBP enabled anatomical reduction of shortened LLC to footprint, and provided good clinical and radiographic outcomes. If further comparative and mechanical study is supported, this technique would be a good treatment option.
Code of conduct/disclaimer available in General Terms & Conditions

By clicking “Accept Terms & all Cookies” or by continuing to browse, you agree to the storing of third-party cookies on your device to enhance your user experience and agree to the user terms and conditions of this learning management system (LMS).

Cookie Settings
Accept Terms & all Cookies