Surgical Outcome of Modified Broström Procedure with Resection of Os Subfibulare or Avulsion Fragment in Chronic Lateral Instability of Ankle Joint

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1 Surgical Outcome of Modified Broström Procedure with Resection of Os Subfibulare or Avulsion Fragment in Chronic Lateral Instability of Ankle Joint Ki-Sun Sung M.D., PhD., Yong-Serk Park M.D., Tae-Hwan Chun M.D., Sung-shan Lee M.D., Keun-ho Lee M.D. Department of Orthopedic Surgery, Samsung Medical Center, College of Medicine, Sungkyunkwan University, Seoul, Korea

2 Surgical Outcome of Modified Broström Procedure with Resection of Os Subfibulare or Avulsion Fragment in Chronic Lateral Instability of Ankle Joint Ki-Sun Sung M.D., PhD., Yong-Serk Park M.D., Tae-Hwan Chun M.D., Sung-shan Lee M.D., Keun-ho Lee M.D. My disclosure is in the Final AOFAS Program Book. I have no potential conflicts with this presentation.

Introduction Modified Broström procedure is

3 Introduction Modified Broström procedure is widely used for chronic lateral instability of the ankle joint What about the ossicle? Osteosynthesis? Reduction and fusion, Kim 2010 Possible non-union and residual symptom, Hasegawa 1996 Resection before Broström? Excision of ossicle, Mancuso 1991

4 Hypothesis We hypothesized that modified Broström procedure with resection of os subfibulare or avulsion fragment could result in good outcome comparing with that of the same procedure for chronic lateral instability patients without any ossicle. Analysis AOFAS ankle-hindfoot pain (40 points) & function (50 points) scale Karlsson score (100 points) Statistical analysis SPSS (SPSS Inc., Chicago, IL) Paired t test, Student t test, Mann-Whitney test, chi-square test

Materials and methods December 2004 ~ December 2010 102 patients(106 ankles) 82 patients(86 ankles) 86 F/U 106 treated with Modified Broström 20 F/U lost Group A (n=40, 46.5%) Group B (n=46, 53.

5 Materials and methods December 2004 ~ December patients(106 ankles) 82 patients(86 ankles) 86 F/U 106 treated with Modified Broström 20 F/U lost Group A (n=40, 46.5%) Group B (n=46, 53.5%) Age (years) 27.3± ± Gender (male:female) Follow-up period (months) 35:5 35: ± ± Modified Broström procedure with a suture anchor after resection of the ossicle Arthroscopic procedure for intra-articular pathologies p Group A 40 with ossicles Group A1 29 Ossicle size <10mm Group A2 11 Ossicle size 10mm Group B 46 without ossicles

6 Results Parameter Group A(Ossicle) Group B(No ossicle) P(<0.05) AOFAS pain score Preoperative 26.4± ± Postoperative 31.8± ± Improvement 5.4± ± AOFAS function score Preoperative 36.9± ± Postoperative 45.9± ± Improvement 9.0± ± Karlsson-Peterson score Preoperative 68.2± ± Postoperative 90.4± ± Improvement 22.2± ±

7 Results Parameter Group OS(Small) Group OL(Large) Group B (No ossicle) P(<0.05) (n=29) (n=11) (n=46) OS:OL OS:N OL:N AOFAS pain score Preoperative 26.4± ± ± Postoperative 31.4± ± ± Improvement 5.0± ± ± AOFAS function score Preoperative 37.2± ± ± Postoperative 46.2± ± ± Improvement 9.0± ± ± Karlsson-Peterson score Preoperative 72.2± ± ± Postoperative 91.8± ± ± Improvement 19.6± ± ±

8 Discussion All the postoperative scores were significantly improved without significant difference between the ossicle group and the non-ossicle group except for Karlsson score in which the ossicle group showed better result. Preoperative Karlsson score was significantly low in the large ossicle group Postoperative scores showed no significant difference between the small ossicle group and the large ossicle group although Karlsson score seemed a bit worse in the large ossicle group

regardless of its size, thus we suggest that osteosynthesis of

9 Conclusion The result of modified Broström procedure after resection of os subfibulare or avulsion fragment was successful regardless of its size, thus we suggest that osteosynthesis of the bony fragment may not be necessary even if the size is considerable.

References 1. Ferkel RD, Chams RN. Chronic lateral instability: arthroscopic findings and long-term results. Foot Ankle Int 2007;28:24-31. 2. Hamilton WG, Thompson FM, Snow SW.

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Stress radiographs under anesthesia for painful chronic lateral ankle instability

Stress radiographs under anesthesia for painful chronic lateral ankle instability Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea *W Institute