title: Comparison of Broström technique, suture anchor repair, and tape augmentation for reconstruction of the anterior talofibular ligament.
abstract: OBJECTIVE
  Recently, tape augmentation for Broström repair has been introduced in order to improve the primary stability of the reconstructed anterior talofibular ligament (ATFL). The biomechanical effect of tape augmentation suture anchor (SA) repair is not known yet. The aim of the present study was to compare construct stability of the traditional Broström (TB) repair compared with a stand alone SA repair (SutureTak, Arthrex) and SA repair combined with tape augmentation (InternalBrace, Arthrex) internal brace (IB) of the ATFL.
  
  
  METHODS
  Eighteen fresh-frozen human anatomic lower leg specimens were randomly assigned to three different groups: TB group, SA group, and IB augmentation group. In vivo torsion conditions in ankle sprain were carried out quasi-statically (0.5°/s). Torque (Nm) required to resist as well as the rotary displacement (°) of the load frame was recorded. Intergroup differences for age, bone mineral density (BMD), angle at failure, and torque at failure were analysed using ANOVA.
  
  
  RESULTS
  In the TB group, ATFL reconstruction failed at an angle of 24.1°, in the SA group failure occurred at 35.5°, and in the IB group it failed at 46.9° (p = 0.02). Torque at failure reached 5.7 Nm for the TB repair, 8.0 Nm for the SA repair, and 11.2 Nm for the IB group (p = 0.04). There was no correlation between angle at ATFL failure, torque at failure, and BMD for the SA or IB groups.
  
  
  CONCLUSIONS
  The present biomechanical study reveals statistically superior performance in terms of angle at failure as well as failure torque for the IB group compared to the other reconstruction methods. BMD did not influence the construct stability in the SA repair groups.
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18 - 20, 1090, Vienna, Austria. reinhard.schuh@meduniwien.ac.at.
authors.forename: R
authors.initials: R
authors.lastname: Schuh
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18 - 20, 1090, Vienna, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Benca
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18 - 20, 1090, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Willegger
authors.affiliation: Center of Anatomy and Cellular Biology, Medical University of Vienna, Vienna, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Hirtler
authors.affiliation: Department of Radiology, Hanusch Hospital, Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Zandieh
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18 - 20, 1090, Vienna, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Holinka
authors.affiliation: Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18 - 20, 1090, Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Windhager
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000601:surgery; D002102:Cadaver; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011897:Random Allocation; D053832:Surgical Tape; D053441:Suture Anchors
keywords: Ankle lateral ligament; Bone mineral density; Broström; Suture anchor; Tape augmentation