title: ArthroBroström Lateral Ankle Stabilization Technique: An Anatomic Study.
abstract: BACKGROUND
  Arthroscopic ankle lateral ligament repair techniques have recently been developed and biomechanically as well as clinically validated. Although there has been 1 anatomic study relating suture and anchor proximity to anatomic structures, none has evaluated the ArthroBroström procedure.
  
  
  OBJECTIVE
  To evaluate the proximity of anatomic structures for the ArthroBroström lateral ankle ligament stabilization technique and to define ideal landmarks and "safe zones" for this repair.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  Ten human cadaveric ankle specimens (5 matched pairs) were screened for the study. All specimens underwent arthroscopic lateral ligament repair according to the previously described ArthroBroström technique with 2 suture anchors in the fibula. Three cadaveric specimens were used to test the protocol, and 7 were dissected to determine the proximity of anatomic structures. Several distances were measured, including those of different anatomic structures to the suture knots, to determine the "safe zones." Measurements were obtained by 2 separate observers, and statistical analysis was performed.
  
  
  RESULTS
  None of the specimens revealed entrapment by either of the suture knots of the critical anatomic structures, including the superficial peroneal nerve (SPN), sural nerve, peroneus tertius tendon, peroneus brevis tendon, or peroneus longus tendon. The internervous safe zone between the intermediate branch of the SPN and sural nerve was a mean of 51 mm (range, 39-64 mm). The intertendinous safe zone between the peroneus tertius and peroneus brevis was a mean of 43 mm (range, 37-49 mm). On average, a 20-mm (range, 8-36 mm) safe distance was maintained from the most medial suture to the intermediate branch of the SPN. The amount of inferior extensor retinaculum (IER) grasped by either suture knot varied from 0 to 12 mm, with 86% of repairs including the retinaculum.
  
  
  CONCLUSIONS
  The results indicate that there is a relatively wide internervous and intertendinous safe zone when performing the ArthroBroström technique for lateral ankle stabilization. While none of the critical anatomic structures was entrapped by the suture knots, it was evident that the IER was included in a majority of the repairs. This study further defines the proximity of adjacent anatomic structures and establishes the anatomic safe zones for the ArthroBroström lateral ankle stabilization procedure.
  
  
  CONCLUSIONS
  By defining this relatively risk-free zone, surgeons who are not as experienced with arthroscopic lateral ligament repair techniques may approach arthroscopic suture passage with more confidence.
authors: Southeast Orthopedic Specialists, Jacksonville, Florida, USA ace4foot@gmail.com.
authors: Jorge I
authors: JI
authors: Acevedo
authors: Clinica Alemana, Santiago, Chile.
authors: Cristian
authors: C
authors: Ortiz
authors: University of Barcelona, Barcelona, Spain.
authors: Pau
authors: P
authors: Golano
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Caio
authors: C
authors: Nery
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D002102:Cadaver; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000601:surgery*; D008297:Male; D008953:Models, Anatomic; D053441:Suture Anchors
keywords: Broström repair; ankle; arthroscopic ankle lateral ligament repair; ligaments