Assessing Lateral Ankle Instability Following Modified Broström Procedure Early Results of a Retrospective Analysis

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Assessing Lateral Ankle Instability Following Modified Broström Procedure Early Results of a Retrospective Analysis Chris Vasileff MS-3 2, Ryan Nowatzke MS-3 2, Andrew Ostosh MS-3 2, John G Anderson,

1 Assessing Lateral Ankle Instability Following Modified Broström Procedure Early Results of a Retrospective Analysis Chris Vasileff MS-3 2, Ryan Nowatzke MS-3 2, Andrew Ostosh MS-3 2, John G Anderson, MD 1, Donald R Bohay, MD, FACS 1, John D Maskill, MD 1, Shaun Kink, MD 1-3, Eric Perez, MD 1-3, Michelle A Padley, CRTM 1, Lindsey Behrend, BS 1 Orthopedic Associates of Michigan [1] Michigan State University College of Human Medicine [2] Grand Rapids Medical Education Partners [3]

2 Disclosures The potential conflicts of interest with this presentation are: Chris Vasileff None Ryan Nowatzke None Andrew Ostosh - None John G Anderson MD Consultant: Stryker, Biomet, BESPA Donald R Bohay MD Consultant: Stryker, Biomet, BESPA John D Maskill MD Consultant: Wright Medical Shaun Kink MD None Eric Perez MD - None Michelle Padley - None Lindsey Behrend None All disclosures are in the Final AOFAS Mobile App

3 Surgical Treatment World Journal of Orthopedics Injuries of the lateral ankle ligaments (ATFL, CFL, ankle capsule) are typically repaired with a Broström-Gould procedure Damaged ligaments are tightened and reattached in addition to securing the inferior retinaculum to the distal fibula

Surgical Procedure Gastrocnemius recession extends the length of the muscle through an incision in the mid-calf Allows increased dorsiflexion and creates a larger contact surface between the inferior

4 Surgical Procedure Gastrocnemius recession extends the length of the muscle through an incision in the mid-calf Allows increased dorsiflexion and creates a larger contact surface between the inferior tibia and superior talus Theoretically, improving dorsiflexion with the gastroc recession puts the ankle mortise in a more anatomical and stable position, thereby reducing complaints of pain and instability associated with arch collapse (plantar fasciitis, metatarsalgia, Achilles tendinopathy)

5 Objectives Primary objective: To assess lateral ankle stability following isolated modified Broström procedure versus concomitant modified Broström and gastrocnemius recession. Secondary objectives Optimal surgical technique Complication rate and overall patient outcomes Post-op outcomes in patients with osteochondral defects

6 Methods Design: Retrospective chart review with patients from the Orthopedic Associates of Michigan Inclusion Criteria All patients 14 years old Patients must have undergone a modified Broström procedure at a Spectrum Health or Metro Health facility from 1/1/ /31/12 by Drs. Anderson, Bohay, or Maskill Exclusion Criteria Any concurrent procedure that, in the opinion of the investigator, affects weight bearing status (Hindfoot fusion, lateralizing calcaneal osteotomy) Genetic defect in collagen (Ehlers-Danlos, Marfan) Insufficient documentation

7 Demographics 513 total patients with 122 who received gastrocnemius recession in conjunction with modified Broström Age (14-85) M:F - 182:331 BMI ( ) Smokers %

8 Results VAS Pain Score Pre-Op Modified Broström: 5.48 Concomitant Gastrocnemius Recession: 6.18 Ø P = VAS Pain Score Post - Op Modified Broström: 1.32 Concomitant Gastrocnemius Recession: 1.11 Ø P = 0.513

9 Results VAS Pain Score Change Modified Broström: (-) 4.05 Concomitant Gastrocnemius Recession: (-) 5.14 Ø P = AOFAS Ankle-Hindfoot Stability Post-Op Gastrocnemius Recession % Modified Broström %

10 Discussion Pain Patients receiving gastrocnemius recession with a modified Broström had increased pain preoperatively but equivalent pain postoperatively as those receiving isolated Broström Patients with modified Broström and concomitant gastrocnemius recession had statistically significant improvement in VAS pain scores compared to patients receiving isolated Broström Stability Substantial difference (~10%) comparing post-op stability in patients who received Gastrocnemius recession

11 Discussion Limitations Incomplete charts/lost to follow up Missing VAS scores Complication rate Unable to assess calf strength Pre-op vs Post-op Surgical technique Consideration of cosmetic issues Retrospective study

12 References 1. Holmer P, Sondergaard L, Konradsen L, et al. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int. 1994;15: Kannus P, Renstrom P. Treatment for acute tears of the lateral ligaments of the ankle: Operation, cast, or early controlled mobilization. J Bone Joint Surg Am. 1991;73: Freeman MAR. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg Br. 1965;47: Gould N, Seligson D, Gassman J. Early and late repair of the lateral ligaments of the ankle. Foot Ankle. 1980;1: Karlsson J, Bergsten T, Lansigner O, Peterson L. Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am. 1988;70: Liu SH, Baker CL. Comparison of lateral ankle ligamentous reconstruction procedures. Am J Sports Med. 1994;22:

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