title: Biomechanical Analysis of an Arthroscopic Broström Ankle Ligament Repair and a Suture Anchor-Augmented Repair.
abstract: BACKGROUND
  Secondary surgical repair of ankle ligaments is often indicated in cases of chronic lateral ankle instability. Recently, arthroscopic Broström techniques have been described, but biomechanical information is limited. The purpose of the present study was to analyze the biomechanical properties of an arthroscopic Broström repair and augmented repair with a proximally placed suture anchor. It was hypothesized that the arthroscopic Broström repairs would compare favorably to open techniques and that augmentation would increase the mean repair strength at time zero.
  
  
  METHODS
  Twenty (10 matched pairs) fresh-frozen foot and ankle cadaveric specimens were obtained. After sectioning of the lateral ankle ligaments, an arthroscopic Broström procedure was performed on each ankle using two 3.0-mm suture anchors with #0 braided polyethylene/polyester multifilament sutures. One specimen from each pair was augmented with a 2.9-mm suture anchor placed 3 cm proximal to the inferior tip of the lateral malleolus. Repairs were isolated and positioned in 20 degrees of inversion and 10 degrees of plantarflexion and loaded to failure using a dynamic tensile testing machine. Maximum load (N), stiffness (N/mm), and displacement at maximum load (mm) were recorded.
  
  
  RESULTS
  There were no significant differences between standard arthroscopic repairs and the augmented repairs for mean maximum load and stiffness (154.4 ± 60.3 N, 9.8 ± 2.6 N/mm vs 194.2 ± 157.7 N, 10.5 ± 4.7 N/mm, P = .222, P = .685).
  
  
  CONCLUSIONS
  Repair augmentation did not confer a significantly higher mean strength or stiffness at time zero.
  
  
  CONCLUSIONS
  Mean strength and stiffness for the arthroscopic Broström repair compared favorably with previous similarly tested open repair and reconstruction methods, validating the clinical feasibility of an arthroscopic repair. However, augmentation with an additional proximal suture anchor did not significantly strengthen the repair.
authors.affiliation: Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA ericgiza@gmail.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Giza
authors.affiliation: Department of Orthopaedics, University of California, Davis, Sacramento, CA, USA Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Whitlow
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Brady T
authors.initials: BT
authors.lastname: Williams
authors.affiliation: Southeast Orthopedic Specialists, Jacksonville, FL, USA.
authors.forename: Jorge I
authors.initials: JI
authors.lastname: Acevedo
authors.affiliation: Blue Ridge Bone and Joint, Asheville, NC, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Mangone
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA The Steadman Clinic, Vail, CO, USA.
authors.forename: C Thomas
authors.initials: CT
authors.lastname: Haytmanek
authors.affiliation: The Carrell Clinic, Dallas, TX, USA.
authors.forename: Eugene E
authors.initials: EE
authors.lastname: Curry
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Travis Lee
authors.initials: TL
authors.lastname: Turnbull
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA The Steadman Clinic, Vail, CO, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Wijdicks
authors.affiliation: The Steadman Clinic, Vail, CO, USA.
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Clanton
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D001696:Biomechanical Phenomena; D006801:Humans; D017844:Lateral Ligament, Ankle / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D053441:Suture Anchors
keywords: ankle sprains; anterior talofibular ligament; arthroscopy; lateral ankle ligaments