[Lateral ankle ligament bracing]

Covering the anatomic reconstruction (Broström procedure) with suture tape for more initial stability. Seat belt principle.

Mechanical lateral ankle instability: athletes in sports at risk, patients with uncertain compliance with respect to the postoperative treatment regimen, patients with poor tissue quality, patients with generalized laxity, and patients with failed previous repairs.

Known implant intolerance, local or systemic infection, local soft tissue affections, hemorrhagic disorders.

Epimalleolar 5 cm skin incision. Anatomic repair of the lateral capsuloligamentous structures to the anterior facet of the lateral malleolus (e.g. Broström repair). Dissection down to origin and insertion of the anterior talofibular ligament (ATFL). Close proximal (fibula) and distal (talar neck) to the ATFL attachments to bone a 2.7 mm (fibular) and a 3.4 mm (talar) drill hole is created and taped with the respective tapes from the single use kit (Arthrex, Naples, FL, USA). Placement of a 3.5 mm × 15.8 mm BioComposite SwiveLock® screw, preloaded with suture tape into the fibula. The free ends of this suture tape are inserted into a 4.75 mm × 19.1 mm SwiveLock® anchor, which is screwed into the talar drill hole under moderate tension of the suture tapes.

Immobilization for 4-5 days postoperatively in a leg and foot Scotchcast^TM. Then, full load bearing within 1-2 days in a stable shoe (OrthoTECH Stabil, OrthoTECH GmbH, Stockdorf, Germany) for 5 postoperative weeks for the day and a night splint (existing Scotchcast^TM). Sensorimotor training initiated in the third and running in the eighth postoperative week. Return to competition in sports at risk (football, basketball, volleyball) 10-12 weeks postoperatively.

Measured with the validated FAAM-G (Foot and Ankle Ability Measure-German version) questionnaire, 9 patients had a preoperative activities of daily living subscale median (minimum-maximum) of 65 (30-100) and increased to 98 (78-100) 12 months postoperatively. Preoperative FAAM-G sport subscale results were 35 (0-75) and 100 (19-100) after 12 months. With the Sefton Grading System, 7 of 8 followed patients had an excellent result and had unrestricted ankle mobility and stable ankles (talar tilt and anterior talar drawer), which is comparable to published suture tape augmentation reports.