title: Modified Broström Procedure for Chronic Ankle Instability With Generalized Joint Hypermobility.
abstract: BACKGROUND
  Chronic ankle instability with generalized joint hypermobility (GJH) is considered a contraindication for the modified Broström procedure. The most widely accepted definition of GJH is a Beighton score of ≥4 on a 9-point scale. However, it is not clear whether this criterion can be applied to determine the GJH that would lead to a poor outcome after a modified Broström procedure. Some of the previous studies that report unfavorable outcomes do not specify the tests or cutoff scores used to determine the GJH, and, in fact, some of the patients with GJH in these studies had good outcomes.
  
  
  OBJECTIVE
  The modified Broström procedure results in satisfactory outcomes in patients who have chronic ankle instability with GJH if the contralateral uninjured ankle shows a normal varus talar tilt and anterior talar translation during stress tests.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Modified Broström procedure was performed in 32 patients with chronic ankle instability with GJH if the contralateral uninjured ankle showed a normal varus talar tilt and anterior talar translation on stress tests. The mean patient age at surgery was 21.7 years, and the mean follow-up duration was 27.4 months.
  
  
  RESULTS
  The Karlsson-Peterson ankle score significantly improved from a mean ± SD of 63.6 ± 7.1 preoperatively to 90.4 ± 6.7 at the final postoperative follow-up (P < .001). Sixteen patients were very satisfied with the results, 10 patients were satisfied, 3 patients rated their satisfaction as fair, and 1 patient was dissatisfied with the results. Nine patients sustained ankle sprains after the surgery, 6 of which were mild sprains. Although 3 of these 9 patients had a mechanically unstable ankle on stress radiographs, they were satisfied with the postoperative results. None of the patients required a reoperation.
  
  
  CONCLUSIONS
  GJH was not a contraindication for the modified Broström procedure if the contralateral uninjured ankle showed a normal varus talar tilt and a normal anterior talar translation on stress tests. Further studies are needed to better define GJH affecting the ankle.
authors.affiliation: Department of Orthopaedic Surgery, The Second Hospital, Jilin University, Changchun, China.
authors.forename: Bingzhe
authors.initials: B
authors.lastname: Huang
authors.affiliation: Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
authors.forename: Yong Tae
authors.initials: YT
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
authors.forename: Jung Uk
authors.initials: JU
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
authors.forename: Jung Hoon
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
authors.forename: Yong Wook
authors.initials: YW
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea hyongnyun@naver.com.
authors.forename: Hyong Nyun
authors.initials: HN
authors.lastname: Kim
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D055815:Young Adult
keywords: ankle sprain; chronic ankle instability; generalized joint hypermobility; modified Broström procedure