title: Combination of modified Broström procedure with ankle arthroscopy for chronic ankle instability accompanied by intra-articular symptoms.
abstract: OBJECTIVE
  To evaluate the effectiveness of the modified Broström procedure combined with ankle arthroscopy for chronic ankle instability (CAI) accompanied by intra-articular symptoms.
  
  
  METHODS
  We identified 85 consecutive patients with CAI (87 ankles). There were 58 male patients (58 ankles) and 27 female patients (29 ankles) with a mean age of 24.4 years (range, 14 to 36 years). All the patients had intra-articular symptoms. Ankle arthroscopic surgery was performed initially to manage any intra-articular lesions. This was followed by the modified Broström procedure, including shortening of the anterior talofibular ligament and/or calcaneofibular ligament, as well as extensor retinaculum augmentation. All the intra-articular lesions found during surgery were recorded. American Orthopaedic Foot & Ankle Society (AOFAS) scores were obtained before surgery and at follow-up.
  
  
  RESULTS
  Intra-articular lesions were found in 79 ankles (90.8%), including 75 with synovitis and soft-tissue impingement, 33 with chondral injuries, 23 with anterior tibial osteophytes, 7 with loose bodies, and 6 with distal tibiofibular syndesmosis injuries. A total of 79 patients (92.9%) (81 ankles) were followed up for a mean of 29 months (range, 12 to 47 months). The mean AOFAS score improved from 46.6 +/- 8.1 preoperatively to 86.5 +/- 7.6 postoperatively (P < .05). Mean postoperative AOFAS scores were significantly higher in patients without chondral lesions than in those with chondral lesions (89.76 +/- 5.88 and 81.35 +/- 7.18, respectively; P < .05). Improvements in AOFAS scores after surgery were significantly greater in patients without chondral lesions than in those with chondral lesions (42.28 +/- 9.04 and 36.06 +/- 11.85, respectively; P < .05).
  
  
  CONCLUSIONS
  The modified Broström procedure combined with ankle arthroscopy produced satisfactory surgical outcomes in patients with CAI and intra-articular symptoms. Accompanying chondral injuries were associated with poorer surgical outcomes.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Hua
authors.forename: Shiyi
authors.initials: S
authors.lastname: Chen
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Li
authors.forename: Jiwu
authors.initials: J
authors.lastname: Chen
authors.forename: Hong
authors.initials: H
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000293:injuries / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult