Lateral ankle ligament bracing

Abstract

Covering the anatomic reconstruction (Broström procedure) with suture tape for more initial stability. Seat belt principle. Mechanical lateral ankle instability: athletes in sports at risk, patients with uncertain compliance with respect to the postoperative treatment regimen, patients with poor tissue quality, patients with generalized laxity, and patients with failed previous repairs. Known implant intolerance, local or systemic infection, local soft tissue affections, hemorrhagic disorders. Epimalleolar 5 cm skin incision. Anatomic repair of the lateral capsuloligamentous structures to the anterior facet of the lateral malleolus (e.g. Broström repair). Dissection down to origin and insertion of the anterior talofibular ligament (ATFL). Close proximal (fibula) and distal (talar neck) to the ATFL attachments to bone a2.7 mm (fibular) and a3.4 mm (talar) drill hole is created and taped with the respective tapes from the single use kit (Arthrex, Naples, FL, USA). Placement of a3.5 mm × 15.8 mm BioComposite SwiveLock® screw, preloaded with suture tape into the fibula. The free ends of this suture tape are inserted into a4.75 mm × 19.1 mm SwiveLock® anchor, which is screwed into the talar drill hole under moderate tension of the suture tapes. Immobilization for 4-5days postoperatively in aleg and foot ScotchcastTM. Then, full load bearing within 1-2days in astable shoe (OrthoTECH Stabil, OrthoTECH GmbH, Stockdorf, Germany) for 5postoperative weeks for the day and anight splint (existing ScotchcastTM). Sensorimotor training initiated in the third and running in the eighth postoperative week. Return to competition in sports at risk (football, basketball, volleyball) 10-12weeks postoperatively. Measured with the validated FAAM-G (Foot and Ankle Ability Measure-German version) questionnaire, 9patients had apreoperative activities of daily living subscale median (minimum-maximum) of65 (30-100) and increased to98 (78-100) 12months postoperatively. Preoperative FAAM-G sport subscale results were35 (0-75) and 100 (19-100) after 12months. With the Sefton Grading System, 7 of 8followed patients had an excellent result and had unrestricted ankle mobility and stable ankles (talar tilt and anterior talar drawer), which is comparable to published suture tape augmentation reports.