A comparative study of all-arthroscopic technique and modified open Broström technique in repair of anterior talofibular ligament with anchors_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YI Gang ^1,2 , FU Shijie ^1,2 , YANG Jing ³ , WANG Guoyou ^1,2 , LIU Yang ^1,2 , GUO Xiaoguang ^1,2 , SHI Jie ^1,2 ,  ZHANG Lei ^1,2

1. Department of Orthopedics, the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Academician Workstation in Luzhou, Luzhou Sichuan, 646000, P.R.China;
3. Department of Gynaecology and Obstetrics, the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

ZHANG Lei, Email: zhanglei870722@126.com

Keywords：

Ankle instability; anterior talofibular ligament; arthroscopy; modified Broström technique; anchor; ligament repair

DOI：

10.7507/1002-1892.201905072

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Objective To compare the effectiveness of all-arthroscopic technique and modified open Broström technique in repair of anterior talofibular ligament (ATFL) for lateral instability of the ankle (LIA).Methods A retrospective analysis was made on 65 patients who underwent ATFL repair with anchors for LIA between January 2014 and January 2017. The ATFL was repaired by all-arthroscopic technique in 35 patients (arthroscopic group) and modified open Broström technique in 30 patients (open group). There was no significant difference in age, gender, the side of injured ankle, the time from injury to operation, and preoperative anterior displacement of talus, tilt angle of talus, the Karlsson Ankle Functional (KAF) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Japanese Society for Surgery of the foot ankle-hindfoot (JSSF) scale score between the two groups (P>0.05). The operation time, the intraoperative bleeding volume, and the length of time for surgery recovery were recorded. The anterior displacement of talus, the tilt angle of talus, KAF score, AOFAS score, and JSSF scale score were evaluated at 2 weeks, 3 months, and the last follow-up.Results All patients were followed up 24-30 months, with an average of 26 months. The operation time, intraoperative bleeding volume, and the length of time for surgery recovery of arthroscopic group were superior to open group (P<0.05). There were 2 cases of temporary ankle and dorsum numbness and 1 case of thread reaction in arthroscopic group; and there were 2 cases of temporary ankle and dorsum numbness and 2 cases of thread reaction in open group. The AOFAS score, KAF score, and JSSF scale score in arthroscopic group were significantly higher than those in open group (P<0.05) at 2 weeks after operation; there was no significant difference between the two groups at 3 months and the last follow-up (P>0.05). There was no significant difference in the anterior displacement of talus and the tilt angle of talus between the two groups at 2 weeks, 3 months, and last follow-up (P>0.05).Conclusion Compared with the modified open Broström technique, the all-arthroscopic technique, as a minimally invasive technique, can achieve the same effectiveness, and has the advantages of shorter operation time, less intraoperative bleeding, and less pain in the early stage.

Citation： YI Gang, FU Shijie, YANG Jing, WANG Guoyou, LIU Yang, GUO Xiaoguang, SHI Jie, ZHANG Lei. A comparative study of all-arthroscopic technique and modified open Broström technique in repair of anterior talofibular ligament with anchors. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(12): 1503-1509. doi: 10.7507/1002-1892.201905072 Copy

1.	Pellegrini MJ, Sevillano J, Ortiz C, et al. Knotless modified arthroscopic-Broström technique for ankle instability. Foot Ankle Int, 2019, 40(4): 475-483.
2.	Higashiyama R, Aikawa J, Iwase D, et al. Anatomical arthroscopic anterior talofibular ligament and calcaneofibular ligament reconstruction using an autogenic hamstring tendon: safe creation of anatomical fibular tunnel. Arthrosc Tech, 2019, 8(3): e215-e222.
3.	张言, 梁晓军. 慢性踝关节外侧不稳的解剖修复治疗进展. 中国修复重建外科杂志, 2016, 30(12): 1551-1555.
4.	Buerer Y, Winkler M, Burn A, et al. Evaluation of a modified Broström-Gould procedure for treatment of chronic lateral ankle instability: A retrospective study with critical analysis of outcome scoring. Foot Ankle Surg, 2013, 19(1): 36-41.
5.	Hassan S, Thurston D, Sian T, et al. Clinical outcomes of the modified Broström technique in the management of chronic ankle instability after early, intermediate, and delayed presentation. J Foot Ankle Surg, 2018, 57(4): 685-688.
6.	江东, 胡跃林, 焦晨, 等. 改良辅助入路全关节镜下修复踝关节外侧副韧带. 中国微创外科杂志, 2019, 19(1): 11-14.
7.	Arroyo-Hernández M, Mellado-Romero M, Páramo-Díaz P, et al. Chronic ankle instability: Arthroscopic anatomical repair. Rev Esp Cir Orthop Traumatol, 2017, 61(2): 104-110.
8.	Yoo JS, Yang EA. Clinical results of an arthroscopic modified Brostrom operation with and without an internal brace. J Orthop Traumatol, 2016, 17(4): 353-360.
9.	Vega J, Guelfi M, Malagelada F, et al. Arthroscopic all-inside anterior talofibular ligament repair through a three-portal and no-ankle-distraction technique. JBJS Essent Surg Tech, 2018, 8(3): e25.
10.	Dong P, Gu S, Jiang Y, et al. All arthroscopic remnant-preserving reconstruction of the lateral ligaments of the ankle: A biomechanical study and clinical application. Biochem Biophys Res Commun, 2018, 505(4): 985-990.
11.	Cottom JM, Baker JS, Richardson PE, et al. A biomechanical comparison of 3 different arthroscopic lateral ankle stabilization techniques in 36 cadaveric ankles. J Foot Ankle Surg, 2016, 55(6): 1229-1233.
12.	Willegger M, Benca E, Hirtler L, et al. Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1015-1021.
13.	Nakasa T, Nakashiro J, Adachi N. Arthroscopic repair of anterior talofibular ligament using the pull-out technique for chronic ankle instability: Case report. J Foot Ankle Surg, 2019, 58(1): 156-160.
14.	Lopes R, Andrieu M, Cordier G, et al. Arthroscopic treatment of chronic ankle instability: Prospective study of outcomes in 286 patients. Orthop Traumatol Surg Res, 2018, 104(8S): S199-S205.
15.	Weng PW, Chen CY, Tsuang YH, et al. A modified Broström repair with transosseous fixation for chronic ankle instability: a midterm followup study in soldiers. Indian J Orthop, 2018, 52(3): 315-321.
16.	陈守勃, 华英汇. 前距腓韧带修复术治疗踝关节外侧不稳定疗效分析. 中国修复重建外科杂志, 2017, 31(4): 427-431.
17.	张言, 梁晓军, 李毅, 等. 改良 Brostöm-Gould 术单纯解剖修复距腓前韧带治疗慢性踝关节外侧不稳的中短期随访研究. 中华骨与关节外科杂志, 2016, 9(5): 427-431.
18.	Batista JP, Del Vecchio JJ, Patthauer L. Arthroscopic lateral ligament repair through two portals in chronic ankle instability. Open Orthop J, 2017, 11: 617-632.
19.	Petrera M, Dwyer T, Theodoropoulos JS, et al. Short- to medium-term outcomes after a modified Broström repair for lateral ankle instability with immediate postoperative weightbearing. Am J Sports Med, 2014, 42(7): 1542-1548.
20.	Maffulli N, Del Buono A, Maffulli GD, et al. Isolated anterior talofibular ligament Broström repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med, 2013, 41(4): 858-864.
21.	Li H, Hua Y, Li H, et al. Activity level and function 2 years after anterior talofibular ligament repair: A comparison between arthroscopic repair and open repair procedures. Am J Sports Med, 2017, 45(9): 2044-2051.
22.	de Leeuw PA, Golanó P, Sierevelt IN, et al. The course of the superficial peroneal nerve in relation to the ankle position: anatomical study with ankle arthroscopic implications. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 612-617.
23.	Santos FF, Santos NR. Arthroscopic treatment of lateral ankle instability. Is there a safe zone? An anatomic study. Foot and Ankle Surgery, 2018. https://doi.org/10.1016/j.fas.2018.11.011.

1. Pellegrini MJ, Sevillano J, Ortiz C, et al. Knotless modified arthroscopic-Broström technique for ankle instability. Foot Ankle Int, 2019, 40(4): 475-483.
2. Higashiyama R, Aikawa J, Iwase D, et al. Anatomical arthroscopic anterior talofibular ligament and calcaneofibular ligament reconstruction using an autogenic hamstring tendon: safe creation of anatomical fibular tunnel. Arthrosc Tech, 2019, 8(3): e215-e222.
3. 张言, 梁晓军. 慢性踝关节外侧不稳的解剖修复治疗进展. 中国修复重建外科杂志, 2016, 30(12): 1551-1555.
4. Buerer Y, Winkler M, Burn A, et al. Evaluation of a modified Broström-Gould procedure for treatment of chronic lateral ankle instability: A retrospective study with critical analysis of outcome scoring. Foot Ankle Surg, 2013, 19(1): 36-41.
5. Hassan S, Thurston D, Sian T, et al. Clinical outcomes of the modified Broström technique in the management of chronic ankle instability after early, intermediate, and delayed presentation. J Foot Ankle Surg, 2018, 57(4): 685-688.
6. 江东, 胡跃林, 焦晨, 等. 改良辅助入路全关节镜下修复踝关节外侧副韧带. 中国微创外科杂志, 2019, 19(1): 11-14.
7. Arroyo-Hernández M, Mellado-Romero M, Páramo-Díaz P, et al. Chronic ankle instability: Arthroscopic anatomical repair. Rev Esp Cir Orthop Traumatol, 2017, 61(2): 104-110.
8. Yoo JS, Yang EA. Clinical results of an arthroscopic modified Brostrom operation with and without an internal brace. J Orthop Traumatol, 2016, 17(4): 353-360.
9. Vega J, Guelfi M, Malagelada F, et al. Arthroscopic all-inside anterior talofibular ligament repair through a three-portal and no-ankle-distraction technique. JBJS Essent Surg Tech, 2018, 8(3): e25.
10. Dong P, Gu S, Jiang Y, et al. All arthroscopic remnant-preserving reconstruction of the lateral ligaments of the ankle: A biomechanical study and clinical application. Biochem Biophys Res Commun, 2018, 505(4): 985-990.
11. Cottom JM, Baker JS, Richardson PE, et al. A biomechanical comparison of 3 different arthroscopic lateral ankle stabilization techniques in 36 cadaveric ankles. J Foot Ankle Surg, 2016, 55(6): 1229-1233.
12. Willegger M, Benca E, Hirtler L, et al. Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1015-1021.
13. Nakasa T, Nakashiro J, Adachi N. Arthroscopic repair of anterior talofibular ligament using the pull-out technique for chronic ankle instability: Case report. J Foot Ankle Surg, 2019, 58(1): 156-160.
14. Lopes R, Andrieu M, Cordier G, et al. Arthroscopic treatment of chronic ankle instability: Prospective study of outcomes in 286 patients. Orthop Traumatol Surg Res, 2018, 104(8S): S199-S205.
15. Weng PW, Chen CY, Tsuang YH, et al. A modified Broström repair with transosseous fixation for chronic ankle instability: a midterm followup study in soldiers. Indian J Orthop, 2018, 52(3): 315-321.
16. 陈守勃, 华英汇. 前距腓韧带修复术治疗踝关节外侧不稳定疗效分析. 中国修复重建外科杂志, 2017, 31(4): 427-431.
17. 张言, 梁晓军, 李毅, 等. 改良 Brostöm-Gould 术单纯解剖修复距腓前韧带治疗慢性踝关节外侧不稳的中短期随访研究. 中华骨与关节外科杂志, 2016, 9(5): 427-431.
18. Batista JP, Del Vecchio JJ, Patthauer L. Arthroscopic lateral ligament repair through two portals in chronic ankle instability. Open Orthop J, 2017, 11: 617-632.
19. Petrera M, Dwyer T, Theodoropoulos JS, et al. Short- to medium-term outcomes after a modified Broström repair for lateral ankle instability with immediate postoperative weightbearing. Am J Sports Med, 2014, 42(7): 1542-1548.
20. Maffulli N, Del Buono A, Maffulli GD, et al. Isolated anterior talofibular ligament Broström repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med, 2013, 41(4): 858-864.
21. Li H, Hua Y, Li H, et al. Activity level and function 2 years after anterior talofibular ligament repair: A comparison between arthroscopic repair and open repair procedures. Am J Sports Med, 2017, 45(9): 2044-2051.
22. de Leeuw PA, Golanó P, Sierevelt IN, et al. The course of the superficial peroneal nerve in relation to the ankle position: anatomical study with ankle arthroscopic implications. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 612-617.
23. Santos FF, Santos NR. Arthroscopic treatment of lateral ankle instability. Is there a safe zone? An anatomic study. Foot and Ankle Surgery, 2018. https://doi.org/10.1016/j.fas.2018.11.011.

Chinese Journal of Reparative and Reconstructive Surgery

A comparative study of all-arthroscopic technique and modified open Broström technique in repair of anterior talofibular ligament with anchors

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