Efficacy evaluation of arthroscopic Broström-Gould procedure for chronic lateral ankle instability

Abstract

Objective To investigate the clinical efficacy of arthroscopic Brostrom-Gould procedure for chronic lateral ankle instability (CLAI). Methods A retrospective case series study was conducted to analyze the clinical data of 36 CLAI patients admitted to Zhejiang Provincial People's Hospital, Second Affiliated Hospital of Shenzhen University, Institute of Orthopedics of Soochow University, and Guangzhou Orthopedic Hospital from August 2016 to July 2017. There were 21 males (21 ankles) and 15 females (15 ankles), aged 18-42 years [(26.5 ± 8.6)years]. The duration from injury to operation ranged from 6 to 30 months [(10.8±1.6)months]. All patients received arthroscopic Brostrom-Gould procedure (anterior talofibular ligament repair, capsular constriction, subextensor ligament reinforcement). The operation time and arthroscopic intra-articular lesions and treatment were recorded, and the wound healing and complications were recorded. The visual analogue score (VAS), front drawer test and varus stress test results, American Orthopedic Foot and Ankle Surgery Society (AOFAS) ankle-hind foot score and Karlsson-Peterson ankle function score were compared before operation, 6 weeks after operation and at the last follow-up. Results All 36 patients were followed up for 18-29 months [(20.5±6.3)months]. The operation time ranged from 45 to 115 minutes [(67.2±18.6)minutes]. During the operation, synovitis hyperplasia of ankle joint was found in 35 patients, scar tissue around ligament in 32, talus cartilage injury in 10, osteophyte in 19 and free body in 5, all of which were treated accordingly. All incisions were healed in the first stage after operation, without joint infection, superficial sural nerve injury or thread stimulation. The ankle varus was slightly limited in two patients after operation and improved after functional rehabilitation. No revision operation was needed at the last follow-up. Front drawer test and inverted stress test results were negative (-). The VAS score was (5.9±1.6)points before operation, (1.9±1.0)points at 6 weeks after operation, and (1.6±0.3)points at the last follow-up, with significant difference compared with that before operation (P<0.01). The AOFAS ankle-hind foot score was (67.4±7.4)points before operation, (89.2±6.8)points at 6 weeks after operation, and (91.7±5.3)points at the last follow-up, with significant difference compared with that before operation (P<0.01). Karlsson-Peterson ankle function score was (65.3±9.6)points before operation, (88.6±5.3)points at 6 weeks after operation, and (90.6±3.8)points at the last follow-up, with significant difference compared with that before operation (P<0.01). Conclusion For CLAI, the arthroscopic Brostrom-Gould procedure can treat the intra-articular lesions and reliably restore the stability of the lateral ankle. At the same time, quick motion recovery can be achieved, with satisfactory short-term curative effect. Key words: Lateral ligament, ankle; Arthroscopy; Joint instability; Anatomical ligament repair