Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction/Background
Chronic lateral ankle instability is a common issue that can result from repeated ankle sprains, leading to ligamentous laxity and functional impairment. The traditional Broström procedure has been widely used to restore ankle stability by directly repairing the lateral ankle ligaments. However, concerns remain regarding early failure due to inadequate ligament healing and the need for prolonged immobilization during rehabilitation.
Methods
A retrospective review of 93 patients who underwent the suture tape-augmented Broström procedure was conducted. The inclusion criteria were patients with persistent ankle instability despite conservation management. The exclusion criteria included prior ankle surgery, severe osteoarthritis, and neurological deficits affecting ankle stability.
The surgical technique involved performing a standard Broström repair, followed by reinforcing the lateral ankle ligament complex with a non-absorbable suture tape anchored into fibula and talus. This augmentation was designed to provide additional mechanical support while still permitting natural joint motion.
Postoperatively, patients followed an accelerated rehabilitation protocol that emphasized early weight-bearing and functional exercises. Outcomes were assessed based on complication rates, re-injury occurrences, and the timeline for returning to unrestricted activity.
Results
None of the patients experienced failure of the repair or recurrent instability during the follow-up period. Compared to traditional protocols, the suture tape augmentation allowed for an accelerated return to functional activity. Military personnel resumed agility drills approximately four weeks earlier than conventional rehabilitation protocols would typically permit. There were no significant postoperative complications such as infections, deep vein thrombosis, or hardware-related irritation. Patients reported minimal pain and swelling, and none required surgical revision.
Discussion
The study’s finding suggests that suture tape augmentation in the Broström procedure provides significant advantages over traditional repair methods. The reinforcement from the suture tape allows for immediate post-surgical stability, reducing the risk of failure due to early ligament stretching. This added support enables earlier weight-bearing and a more aggressive rehabilitation approach, which is particularly beneficial for high-performance populations such as athletes and military personnel.
Additionally, the study highlights that while some surgeons may hesitate to introduce synthetic augmentation into soft tissue repairs due to concerns about long-term biocompatibility, the suture tape used in this procedure did not result in adverse reactions. The ability to maintain the native ligament’s natural function while providing supplemental stability makes this approach a promising alternative to conventional Broström repair.
Potential limitations of the study include its retrospective nature and the lack of long-term follow-up data. Future research should focus on randomized controlled trials to compare suture tape-augmented repairs directly with traditional Broström procedures over extended periods.
Conclusion
The suture tape-augmented Broström procedure is a safe and effective technique for treating chronic lateral ankle instability. It provides immediate mechanical stability, reduces the risk of failure, and allows for early functional rehabilitation without increasing the likelihood of complications. Given these benefits, the procedure may be particularly well-suited for individuals who require a rapid return to activity, such as military personnel and athletes. This study supports wider adoption of this technique in clinical practice and suggests that it could improve surgical outcomes for patients with chronic ankle instability.
References
Martin, K. D., Old, S. B., Dauer, E. A., Hutton, J. R., & Bahr, R. A. (2020). Suture tape-augmented Broström procedure and early accelerated rehabilitation: A retrospective comparison of augmented and nonaugmented repair. Foot & Ankle International, 41(12), 1523-1532. https://doi.org/10.1177/1071100720959015