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Searching for an Endoscopic All-Inside Classic Brostrom-Gould Technique.

ABSTRACT: Ankle sprains represent one of the most common injuries sustained by professional and recreational athletes. For those who develop chronic instability requiring surgery, the Broström-Gould procedure has been advocated as the gold standard treatment. Many arthroscopic techniques have been developed in the attempt to replicate this procedure. However, since both calcaneofibular ligament and inferior extensor retinaculum are extra-capsular structures, some of these techniques include a stand-alone repair of the anterior talofibular ligament, while others add a mini-open or a percutaneous modification to perform the Gould augmentation. In our technique, lateral ankle endoscopy provides a clear view and access to these structures, allowing for an all-inside Broström-Gould using three portals. The procedure is safe and reproducible, resulting in a repair that mostly resembles the classical open technique.

SUBMITTER: Atilano Carvalho P

PROVIDER: S-EPMC9052146 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Searching for an Endoscopic All-Inside Classic Broström-Gould Technique.

Atilano Carvalho Pedro P Fradet Juliette J Oliveira Filipa F Charpail Christel C Guillo Stéphane S

Arthroscopy techniques 20220328 4

Ankle sprains represent one of the most common injuries sustained by professional and recreational athletes. For those who develop chronic instability requiring surgery, the Broström-Gould procedure has been advocated as the gold standard treatment. Many arthroscopic techniques have been developed in the attempt to replicate this procedure. However, since both calcaneofibular ligament and inferior extensor retinaculum are extra-capsular structures, some of these techniques include a stand-alone ...[more]

PMID: 35493053

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Project description:BackgroundAnkle sprains are a common musculoskeletal injury among the general population and often involve the lateral ligament complex. Although the majority of ankle sprains are treated successfully with nonsurgical conservative measures, an estimated 5% to 20% of ankle injuries ultimately develop chronic lateral ankle instability (CAI). Multiple surgical treatment modalities for the lateral ankle complex exist, such as anatomical and nonanatomical reconstruction. The current gold standard for primary surgical repair is the Broström-Gould procedure. This is the first article to provide PROMIS scores following BG and the largest study with 5-year outcomes for an open BG.MethodsThis was a descriptive study of a retrospective cohort of patients undergoing a BG with a minimum follow-up of 5 years. Patient-reported outcome instruments collected postoperatively were PROMIS Pain, Physical Function, Depression, and FAAM. Further preoperative clinic characteristics were analyzed to correlate with the final outcome. The electronic medical record was queried for Current Procedural Terminology (CPT) code 27698 (Broström-Gould) from January 2010 to June 2017. Surveys were conducted in the clinic and through phone interviews. Patient charts were reviewed to obtain basic patient demographic information including sex, age, race, and body mass index (BMI). The following preoperative variables were recorded: history of prior CAI procedures, history of major trauma, duration of symptoms, number of diagnosed ankle sprains, other collagen pathologies, generalized ligament laxity, participation in sports/activity level, peroneal subluxation, clinically diagnosed peroneus longus or brevis tendinopathy, deltoid ligament injury, anterior ankle impingement, and posterior ankle impingement. The PROMIS and Foot and Ankle Ability Measure (FAAM) scores were obtained with a combination of clinic and phone interviews. Data were aggregated in Microsoft Excel and entered in R (version 4.2.0) for statistical analysis.ResultsOur results show that the minimum 5-year patient-reported PROMIS scores for patients following a Broström-Gould procedure are as follows: PROMIS physical function, 50.5; PROMIS pain interference, 48.2; and PROMIS depression, 38.2. This indicates, at a minimum, that patients 5 years removed from the procedure are within 1 SD of the general population in regard to PROMIS physical function and pain. Our patient-reported FAAM, activities of daily living, and FAAM sports scores were 59.6 and 13.0 respectively. Preoperative magnetic resonance imaging (MRI) findings were recorded. Arthroscopic examination was performed before lateral ligaments reconstruction for patients with intra-articular pathologies confirmed on MRI.ConclusionThe findings from our study offer evidence supporting the effectiveness of the Broström-Gould procedure to be associated with normal physical function, even 5 years after surgery. Furthermore, our research identified specific factors such as tobacco use, diabetes, and sports participation that independently correlated with reported outcome measures. These insights enable physicians to better manage patient expectations and tailor treatment strategies accordingly. Our study establishes a foundation for future prospective research endeavors that aim to leverage the PROMIS system for comprehensive outcome assessments.Level of evidenceLevel III, retrospective cohort study.

Project description:Little is known about the factors affecting the intermediate outcomes of the Brostrom-Gould repair as measured by new patient-reported outcome instruments and the impact of patient resilience on postoperative outcomes. This is the first study to investigate the impact of resilience on the outcomes of lateral ligament repair. Retrospectively, 173 patients undergoing Brostrom-Gould at single institution from January 2013 to June 2020 were identified. Patient characteristics, participation in athletic activities, surgical variables, and complications were recorded. Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference v1.1 (PI), Physical Function v1.2 (PF), and the Foot Ankle Ability Measure (FAAM) were collected. The Brief Resilience Scale was used to quantify resilience. A linear regression model was constructed to evaluate the independent effect of resilience on each PROMIS and FAAM outcome instrument. Variables were included in the regression model based on an a priori significance threshold of P <0.05 in bivariate analysis. Resilience's independent effect on outcome measures was as follows: PROMIS PF (unstandardized β 8.2, 95% confidence interval [CI] 3.9 to 12.6), PROMIS PI (unstandardized β -4.8, 95% CI -7.9 to -1.7), FAAM Activities of Daily Living (unstandardized β 16.6, 95% CI 8.7 to 24.6), and FAAM Sports (unstandardized β 28.4, 95% CI 15.9 to 40.9). Preoperative participation in athletic activities also had a positive independent effect on multiple outcome metrics including PROMIS PF (unstandardized β 9.4, 95% CI 2.8 to 16.0), PROMIS PI (unstandardized β -5.3, 95% CI -10.0 to -0.582), and FAAM Sport scores (unstandardized β 34.4, 95% CI 15.4 to 53.4). Resilience and patient participation in athletic activities are independent predictors of improved postoperative functional outcomes as measured by PROMIS and FAAM instruments at intermediate term follow-up. Resilient patients and athletes reported markedly higher PF and less pain burden postoperatively. Preoperative quantification of resilience could enable improved prognostication of patients undergoing lateral ligament repair of the ankle.

Dataset Information

Searching for an Endoscopic All-Inside Classic Brostrom-Gould Technique.

Publications

Searching for an Endoscopic All-Inside Classic Broström-Gould Technique.

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