title: Outcomes of the Modified Broström Procedure Augmented With Suture-Tape for Ankle Instability in Patients With Generalized Ligamentous Laxity.
abstract: BACKGROUND
  Although recent biomechanical studies have reported mechanical superiority of augmented anterior talofibular ligament reconstruction using suture-tape, clinical evidence regarding the efficacy of suture-tape augmentation is still insufficient. This prospective study was performed to evaluate the outcomes of the modified Broström procedure augmented with suture-tape for chronic ankle instability with generalized ligamentous laxity, which has been known to be a poor prognostic factor for anatomic ligament repair.
  
  
  METHODS
  Twenty-eight patients with generalized ligamentous laxity were followed for more than 2 years after the augmented modified Broström procedures for chronic ankle instability. Generalized ligamentous laxity was defined as a Beighton score ≥4 points. The clinical evaluation consisted of the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM) score. Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical ankle stability.
  
  
  RESULTS
  FAOS and FAAM scores had significantly improved from preoperative average 63.2 and 54.3 points to 90.6 and 89.5 points at final follow-up, respectively ( P < .001). Talar tilt angle and anterior talar translation had significantly improved from preoperative average 16.2° and 12.1 mm to 3.6° and 4.2 mm at final follow-up, respectively ( P < .001). Preoperative side-to-side comparison with stress radiographs was significantly different, but this returned to within nonstatistical differences at final follow-up, respectively ( P = .105, .532). Although 6 patients sustained an ankle sprain after operation, only 1 patient (3.6%) showed a recurrence of subjective and mechanical instability.
  
  
  CONCLUSIONS
  Suture-tape augmentation for the modified Broström procedure appears to be an effective operative alternative for chronic ankle instability with generalized ligamentous laxity. As one of the methods to improve the clinical outcomes in patients with relative contraindications of the modified Broström repair, this procedure provided reliable stability with the advantages of anatomic ligament repair through the augmentation using suture-tape.
  
  
  METHODS
  Level IV, prospective case series.
authors.affiliation: 1 Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Byung-Ki
authors.initials: BK
authors.lastname: Cho
authors.affiliation: 1 Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Kyoung-Jin
authors.initials: KJ
authors.lastname: Park
authors.affiliation: 1 Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Ji-Kang
authors.initials: JK
authors.lastname: Park
authors.affiliation: 2 Department of Orthopaedic Surgery, School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: Nelson F
authors.initials: NF
authors.lastname: SooHoo
mesh_terms: D000842:Ankle / Q000601:surgery*; D016512:Ankle Injuries / Q000601:surgery; D001168:Arthritis / Q000601:surgery*; D005205:Fascia / Q000503:physiopathology*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000601:surgery*; D011446:Prospective Studies; D011859:Radiography; D013537:Sutures
keywords: ankle; chronic instability; generalized ligamentous laxity; modified Broström procedure; suture-tape augmentation