Outcomes of Revision Modified Broström Procedure with Periosteal Flap Augmentation in Patients with Recurrent Chronic Ankle Instability.

Background: Although the modified Broström procedure (MBP) is widely accepted as the standard surgical treatment for chronic ankle instability (CAI), recurrent instability remains a clinical challenge, particularly in patients with poor tissue quality or high functional demands. To overcome these limitations, periosteal flap augmentation has been proposed as a biological alternative for patients with recurrent CAI after failed MBP. This study evaluated the clinical and radiographic outcomes of revision MBP with periosteal flap augmentation.

Methods: Fourteen patients (mean age, 29.5 years; range, 18-45 years) who underwent revision MBP combined with periosteal flap augmentation between 2018 and 2023 were retrospectively reviewed. The mean follow-up duration was 23.7 months (18-32 months). Clinical outcomes were assessed using the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Karlsson-Peterson score. Radiographic evaluation included talar tilt angle and anterior talar displacement.

Results: At a mean follow-up of 23.7 months (18-32 months), all clinical scores improved significantly (VAS: 5.9 to 1.6; AOFAS: 64.1 to 90.6; Karlsson-Peterson: 50.7 to 90.0; p < 0.001). Radiographic stability also improved significantly (talar tilt: 10.7° to 4.9°; anterior displacement: 8.9 mm to 4.1 mm; p < 0.001). No recurrent instability was observed. Three patients had minor wound complications, all of which resolved with conservative treatment.

Conclusions: Revision MBP with periosteal flap augmentation showed favorable short-term clinical and radiographic outcomes in patients with recurrent CAI after failed MBP. This technique may serve as a useful autologous reinforcement option in selected revision cases.