Modified Broström Procedure for Chronic Ankle Instability With Generalized Joint Hypermobility

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanics

Background:

• Chronic ankle instability (CAI) with generalized joint hypermobility (GJH) is often considered a contraindication for the modified Broström procedure.
• The standard definition of GJH (Beighton score ≥4) may not accurately predict outcomes after this surgery.
• Previous studies have conflicting results regarding GJH and modified Broström outcomes.

Purpose of the Study:

• To evaluate the efficacy of the modified Broström procedure in patients with CAI and GJH.
• To determine if contralateral ankle stability on stress tests can identify suitable candidates with GJH for the procedure.

Main Methods:

• A case series of 32 patients with CAI and GJH who underwent the modified Broström procedure.
• Inclusion criteria required normal varus talar tilt and anterior talar translation in the contralateral ankle on stress tests.
• Mean patient age was 21.7 years, with a mean follow-up of 27.4 months.

Main Results:

• Significant improvement in Karlsson-Peterson ankle scores from 63.6 preoperatively to 90.4 postoperatively (P < .001).
• High patient satisfaction: 16 very satisfied, 10 satisfied, 3 fair, 1 dissatisfied.
• Nine patients experienced post-operative sprains, but none required reoperation, and some with instability remained satisfied.

Conclusions:

• GJH is not an absolute contraindication for the modified Broström procedure in CAI.
• Contralateral ankle stability on stress testing is a key factor for successful outcomes in these patients.
• Further research is needed to refine the definition of GJH relevant to ankle instability surgery.