The Broström procedure is a surgical technique commonly used to repair chronic lateral ankle instability (CLAI), a condition often caused by repeated sprains of the ankle ligaments. The lateral ankle ligaments, including the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), play a crucial role in maintaining the stability of the ankle joint. When these ligaments are stretched or torn, it can lead to ongoing instability, making it difficult for patients to perform daily activities or engage in sports.
What is the Broström Procedure?
The Broström procedure is designed to repair damaged lateral ankle ligaments. It typically involves suturing the torn ends of the ATFL and CFL and then reattaching them to the fibula bone of the lower leg, which is the primary anchor for these ligaments. The aim is to restore the strength and stability of the ankle to prevent further injuries.
In cases of severe damage to the ligaments, a modification of the procedure, called the Broström-Gould technique, may be used. This involves reinforcing the repaired ligaments with the extensor retinaculum, a tissue located on the front of the ankle, which helps to provide additional support.
Advances in the Broström Procedure: Augmentation with Suture Tape
Recent advancements in the Broström procedure include the use of InternalBrace™ technology. This approach involves the use of a suture tape placed in the repaired ligaments to provide extra strength and prevent them from stretching during the healing process. The addition of the InternalBrace™ allows for a faster recovery and a more robust repair. Studies have shown that this modification of the Broström procedure can improve outcomes, especially for athletes or individuals who require a quicker return to physical activity.
A study involving 81 patients who underwent this augmented Broström procedure with InternalBrace™ showed encouraging results. The average time for patients to return to sport was about 84 days, which is significantly faster compared to traditional rehabilitation times of up to 6 months. The patients in this study also reported minimal pain and high levels of satisfaction with the results.
Rehabilitation After the Broström Procedure
One of the challenges of ankle ligament surgery is the rehabilitation process, which can be lengthy and often requires immobilization of the ankle for several weeks to allow the ligaments to heal. Traditionally, patients needed to wear a cast for up to 6 weeks after surgery, followed by an extended period of rehabilitation. This long recovery time was especially challenging for athletes and active individuals.
With the addition of the InternalBrace™ technology, however, rehabilitation can be accelerated. Patients are typically allowed to start moving their ankle within a couple of weeks and are encouraged to bear weight as soon as they feel comfortable. This early mobilization helps prevent stiffness and promotes faster healing. A structured rehabilitation program that includes physical therapy and strength training is essential for restoring full function to the ankle.
Clinical Outcomes and Patient Satisfaction
Patients who undergo the Broström procedure, especially when augmented with suture tape, typically experience excellent clinical outcomes. Most patients report a significant reduction in pain and a return to normal activities. The Foot and Ankle Ability Measure (FAAM) and the American Orthopaedic Foot and Ankle Society (AOFAS) scores are commonly used to assess functional outcomes, with patients showing marked improvements in both subjective measures of ankle stability and objective tests of ankle strength and range of motion.
In one study, patients who had undergone the augmented Broström procedure with InternalBrace™ achieved an average AOFAS score of 94.3, which indicates nearly perfect ankle function. Additionally, a significant percentage of patients reported returning to sport or their usual level of physical activity within just a few months after surgery.
Complications and Risks
As with any surgical procedure, there are risks involved with the Broström procedure. The most common complications include infection, wound healing problems, and the possibility of re-injury. However, these complications are relatively rare, and most patients recover well with appropriate post-surgical care.
In some cases, patients may experience stiffness or limited range of motion, especially if they do not adhere to their rehabilitation program. Fortunately, with the use of the InternalBrace™, the chances of re-injury and the need for prolonged immobilization are reduced, allowing patients to regain their strength and stability more quickly.
Conclusion
The Broström procedure, especially when combined with the InternalBrace™ augmentation, is a highly effective treatment for chronic lateral ankle instability. It provides a stable, lasting repair that enables patients to return to their normal activities, including sports, in a fraction of the time required by traditional methods. With accelerated rehabilitation and high levels of patient satisfaction, this modern approach to ankle ligament repair offers a promising solution for those suffering from chronic ankle instability.
For individuals experiencing chronic ankle instability, it is important to consult with an orthopedic surgeon who specializes in foot and ankle conditions. The Broström procedure, with or without the InternalBrace™ augmentation, can significantly improve ankle stability and overall quality of life.
Do you have more questions?
Q. What is the Broström procedure used for?
A. The Broström procedure is a surgical technique designed to repair chronic lateral ankle instability (CLAI), particularly caused by repeated sprains that damage the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
Q. How is the Broström procedure performed?
A. The procedure involves suturing the torn ligaments and reattaching them to the fibula to restore the stability of the ankle. In severe cases, the Broström-Gould technique may be used to reinforce the ligaments with additional tissue support.
Q. What is the advantage of the InternalBrace™ technology in the Broström procedure?
A. The InternalBrace™ technology involves using a suture tape to augment the repaired ligaments, providing extra strength and preventing them from stretching during the healing process. This modification allows for faster recovery and improved outcomes, especially for athletes.
Q. What is the recovery process after the Broström procedure?
A. Recovery involves wearing a boot or cast for several weeks, followed by rehabilitation. With InternalBrace™ augmentation, patients can begin moving the ankle and bearing weight sooner, typically returning to sports in about 3 months.
Q. What are the risks and complications of the Broström procedure?
A. Risks include infection, wound healing problems, re-injury, and possible stiffness or limited range of motion. However, complications are rare, and most patients recover well with appropriate care.
Q. How soon can I return to sports after the Broström procedure?
A. Most patients can return to sports or regular physical activity within 3 to 4 months, especially with the use of InternalBrace™ technology, which accelerates rehabilitation.
Q. What is the success rate of the Broström procedure?
A. The success rate is generally high, with most patients experiencing significant pain relief, improved stability, and return to normal activities. Some studies show a success rate of over 90%.
Q. How long does the Broström procedure take?
A. The surgery typically takes about 1 to 2 hours, depending on the complexity of the ligament damage and the specific surgical technique used.
Q. Is physical therapy necessary after the Broström procedure?
A. Yes, physical therapy is essential to regain strength, flexibility, and stability in the ankle. It helps prevent stiffness and ensures a full recovery by improving range of motion and muscle strength.
Q. Will I need to wear a cast after the Broström procedure?
A. Yes, you will likely need to wear a walking boot or cast for several weeks after surgery to protect the ankle and allow the ligaments to heal properly.
Q. Can the Broström procedure be done on both ankles at the same time?
A. While it is technically possible to perform the procedure on both ankles at the same time, it is generally recommended to treat one ankle at a time to allow for proper healing and rehabilitation.
Q. Is the Broström procedure suitable for everyone with ankle instability?
A. The Broström procedure is most effective for individuals with chronic lateral ankle instability, particularly those who have had repeated ankle sprains. It may not be suitable for patients with severe arthritis or extensive bone damage.
Q. How long does it take to regain full function after the Broström procedure?
A. Full recovery typically takes 4 to 6 months, with most patients returning to normal activities within 3 months, depending on the severity of the instability and adherence to rehabilitation.
Q. Can the Broström procedure fail or result in recurrent instability?
A. While rare, the procedure can fail if the ligaments do not heal properly or if the ankle is re-injured. Factors such as poor post-surgical rehabilitation or returning to activities too soon can contribute to recurrence.
Q. Are there non-surgical alternatives to the Broström procedure?
A. Non-surgical treatments include physical therapy, bracing, and rest. These treatments are typically recommended for mild cases of ankle instability but may not be effective for severe or chronic instability. Surgery is often the best option when conservative treatments fail.
Dr. Mo Athar
