Brostrom: Re
Brostrom Repair Is Easy, Reliable and Has Few Complications The following relations exists Royalties and stock options – Smith and Nephew, Wolters Kluwer Consulting income – Smith and Nephew, Geistlich, Ossur, Cannuflow Research and educational support – Mitek, Smith & Nephew & Arthrex
Ankle Sprains 40% of all Athletic Injuries 10% of ER Visits One Inver. Injury /10,000/Day
Introduction Most Patients With Acute Ankle Sprains Heal With Conservative Treatment - RICE, Brace, PT A Small Minority of Patients Will Develop Chronic Lateral Ankle Instability and Require Surgical Stabilization 13% - 35% of Patients Will Continue to Experience Pain After Lateral Ankle Stabilization
Instability Functional - Motion Beyond Voluntary Control But Not Necessarily Exceeding Physiologic ROM P.T.
Instability Mechanical – Motion Beyond Normal Physiologic Limits of Ankle Joint i.e. Increased Anterolateral Laxity SURGERY
Why Do Some People Have Repetitive Sprains That Lead to Chronic Instability?
Lateral Ankle Sprains: Predisposing Factors Proprioceptive Dysfunction Peroneal Tendon Tears of Subluxation Varus Tibial Plafond Varus Heel Posteriorly Positioned Fibular
Chronic Instability Surgery Failure of Conservative Rx Anatomic Repair is Best Open vs. Arthroscopic Non Anatomic Repair – Many Choices
Brostrom-Gould Procedure Procedure Also Called “Modified Brostrom” Reefing Torn ATFL and CFL Restores Anatomic Stability Gould Modif. Limits Inversion and Helps Correct Subtalar Instability
Arthroscopic Technique Supine, 2.7 mm 30° and 70 ° Scope Thigh Holder Look Anterior & Posterior Distracter as Needed
Unstable Ankle – Scope Findings Ferkel and Komenda – 55 Ankles Treated With Lateral Ankle Stabilization 93% Had Joint Abnormalities That Included: Synovitis = 39 Loose Body = 12 Ossicles = 14 OLT = 9 (16%) FAI 20:708, 1999
Unstable Ankle – Scope Findings Seen at Seen Ferkel & Chams Arthroscopy During Brostrom 21 Pts Had Synovitis 16 3 Brostrom-Gould Adhesions 10 2 Chondromalac 7 1 ia 95% Had Ossicles 6 2 Associated Loose Bodies 5 0 OLT 4 1 Intraarticular Osteophyte 4 1 Abnormalities TOTAL 52 10 FAI 28: 24, 2007
Operative Technique After Arthroscopy, the Patient is Repositioned
Operative Technique Ankle is reprepped and draped and all new instruments are used
Brostrom – Gould Procedure Surgical Options Reef Ligaments Leaving Cuff on Fibula Shorten Ligaments Drill Holes into Fibula Suture Anchors Into Fibula
Brostrom Incisions
Brostrom-Gould Procedure Key Must Find “Soft Spot” B/N AITFL and ATFL Place Clamp Into This Area Under Lateral Ligaments Peroneal Tendons Are Protected and Ligaments Incised
Ligament/Capsule Release A B C
Pants Over Vest Ligament Repair
Final Closure
Post-op Treatment NWB SLC for 2 Weeks FWB SLC or CAM Walker for 4 Weeks P.T. Include Pool & Land
BROSTROM Results E-G Brostrom, 1966 97% Gould, 1980 100% Hamilton, 1993 96% Ferkel, 2000 95% Kelikian, 2000 91%
Chronic Ankle Instability Choi et al – 65 Ankles Who Had Modified Brostrom Reconstruction Karlsson- Peterson Score: 53 → 85 63/65 (97%) Had Intraarticular Lesions Factors Ass. With Poor Result Widening Syndesmosis OLT AJSM 36:2167, 2008 Ossicles
Conclusion Brostrom – Gould - Anatomic Reconstruction is Best Choice for Most Patients In Certain Pts a ST Allograft Brostrom Reconstruction is Indicated, Either Primarily or in Revision Surgery Regardless of the Procedure, Do Not Over Tighten The Repair & “Capture” the Ankle Anatomic Ankle Motion Must Be Maintained As Much As Possible
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