Broström procedure

Introduction

There are numerous operative procedures designed to correct mechanical instability of the lateral ankle ligaments. Most of these operations have favorable clinical results, but there are contradictory results from different investigators. Consequently, it is difficult to arrive at a consensus as to the optimal surgical treatment for chronic lateral ankle instability.

Two of the most commonly used surgical procedures are the Evans Technique and the Broström Procedure. Several recent studies have been undertaken to establish the comparative effectiveness of these two techniques.

The Gould modification of the Broström procedure was popularized by Hamilton et al and involves direct repair of the ruptured lateral ankle ligaments and reinforcement with the extensor retinaculum. It has the advantage of improving stability while maintaining motion of the ankle and hindfoot.

Recent Test Results

The Recent study demonstrated that both Procedures were able to improve the stability of the ankle, but the effectiveness of each procedure was dependent on the direction of the stress applied (inversion or internal rotation) and the position of the ankle in dorsiflexion-plantarflexion. Both procedures improved inversion stability. The modified Broström procedure did not cause restricted movement at the subtalar joint level. This is consistent with the success of the modified Broström procedure in elite athletes who require full mobility of the ankle and hindfoot, such as ballet dancers. The Evans Technique abnormally increased inversion stiffness particularly at the subtalar level. It is consistent with the clinical observation of restricted inversion motion after the Evans Technique. It is also consistent with the radiologic observation of degenerative changes or osteophyte formation in the ankle and hindfoot in longer-term studies; an indication of abnormal joint kinematics. Neither operation was successful in restoring normal internal rotation stability.