title: Feasibility and outcome of inferior extensor retinaculum reinforcement in modified Broström procedures.
abstract: BACKGROUND
  The purpose of this study was to assess the feasibility of inferior extensor retinaculum (IER) reinforcement and analyze differences in clinical and radiographic outcomes based on whether or not IER reinforcement was performed in modified Broström procedures.
  
  
  METHODS
  Forty-one patients (41 ankles) who underwent ankle reconstruction with either a Broström procedure or modified Broström with IER reinforcement were included in this prospective study. During Broström procedures, feasibility of IER reinforcement was recorded. Clinical and radiographic outcomes were analyzed between modified Broström procedures (MBP group) in which IER reinforcement was feasible and Broström procedures (BP group) in which IER reinforcement was not feasible.
  
  
  RESULTS
  IER reinforcement was feasible in 31 cases (75.6%) and not feasible in 10 cases (24.4%) due to anatomic variations. The American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved in the MBP group from a preoperative mean of 66.3 to a postoperative mean of 89.4. In the BP group, the score increased from 71.3 to 89.8. The radiographic outcomes assessed by stress radiographs demonstrated that talar anterior translation and talar tilt improved from 6.3 mm to 4.6 mm and from 9.0 degrees to 5.0 degrees, respectively, in the MBP group. In the BP group, talar anterior translation improved from 6.9 mm to 4.9 mm and talar tilt, from 9.5 degrees to 4.9 degrees. No statistically significant difference was observed between the 2 groups.
  
  
  CONCLUSIONS
  IER reinforcement was feasible in 75.6% of patients in whom modified Broström procedures had been planned. Postoperative clinical and radiographic outcomes were not significantly different based on whether or not IER reinforcement was performed. These findings suggest that isolated ligament reconstruction without IER may be sufficient to restore ankle stability.
  
  
  METHODS
  Level II, cohort study.
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea biojeong@khmc.or.kr.
authors.forename: Bi O
authors.initials: BO
authors.lastname: Jeong
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Myung Seo
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Wook Jae
authors.initials: WJ
authors.lastname: Song
authors.affiliation: Department of Orthopaedic Surgery, UCLA School of Medicine, Los Angeles, CA, USA.
authors.forename: Nelson F
authors.initials: NF
authors.lastname: SooHoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: anterior talofibular ligament; calcaneofibular ligament; chronic ankle instability; inferior extensor retinaculum; modified Broström procedure