title: A prospective outcome and cost-effectiveness comparison between two ligament reattachment techniques using suture anchors for chronic ankle instability.
abstract: BACKGROUND
  There are various ligament reattachment techniques for the modified Brostrom procedure. There have been few comparative studies on recently developed techniques. This prospective study was performed to compare the functional outcomes of 2 different ligament reattachment techniques using suture anchors. We furthermore evaluated the cost-effectiveness of the suture bridge technique.
  
  
  METHODS
  Forty-five amateur athletes under 30 years of age were followed for more than 2 years. Twenty-four procedures with the suture anchor technique and 21 procedures with the suture bridge technique were performed by one surgeon. The functional evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson score, Sefton grading system, and the period to return to various forms of exercise (jogging, spurt running, jumping, one leg standing for >1 minute, walking on uneven ground, and going down stairs). Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical stability.
  
  
  RESULTS
  There were no significant differences on AOFAS score, FAOS, Karlsson score, Sefton grade, and stress radiographs. There were no significant differences on the return to exercises, except for jumping. As the most common complication, there were 3 cases of skin irritation by suture materials in the suture anchor group and 2 cases of intraoperative breakage of the suture anchor in suture bridge group.
  
  
  CONCLUSIONS
  Both ligament reattachment techniques using suture anchors showed similar functional outcomes. Considering the additional medical expenses incurred by more suture anchors, the modified Brostrom procedure using the suture bridge technique had low cost-effectiveness. Proper indication and clinical usefulness of suture bridge technique for chronic ankle instability will be addressed in further studies.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea titanick25@naver.com.
authors.forename: Byung-Ki
authors.initials: BK
authors.lastname: Cho
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Yong-Min
authors.initials: YM
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Kyoung-Jin
authors.initials: KJ
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Ji-Kang
authors.initials: JK
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Do-Kyoon
authors.initials: DK
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000191:economics* / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D053441:Suture Anchors / Q000191:economics*; D055815:Young Adult
keywords: chronic ankle instability; functional outcome; modified Brostrom procedure; suture anchor; suture bridge technique