Is internal brace augmentation better than isolated modified Brostrom-Gould repair for chronic lateral ankle instability: effect on functional outcome and return to preinjury activity

N. Jain, B. Ayyaswamy, A. Griffiths, E. Alderton, M. Kostusiak, R. Limaye

Introduction: Modified Brostrom Gould (MBG) repair is widely accepted procedure for chronic lateral ankle instability(CLAI), but there are limitations with regards to strength of repair and risk of reinjury and complications. Internal brace has been recently used as augmentation of standard MBG repair. It provides stronger construct, facilitates early mobilisation and protects repaired ligament with minimal surgical morbidity. The aim of present study is to compare the outcome of MBG repair without and with Internal brace augmentation(IB) in CLAI.

Methods: Retrospective analysis of 172 patients with CLAI who underwent MBG repair with or without IBA between November 2017 and October 2019. Patients were evaluated for Visual analogue scale (VAS), Manchester-oxford foot questionnaire (MOxFQ), Patients subjective satisfaction and return to preinjury activity level.

Results: 148 patients were included in the study with 87 in MBG group and 61 in IB group. The mean age, average injury-surgery interval and mean follow up duration was 40.6 ± 11.1 vs 37.5 ±14.7 years, 13.1 ± 10.3 vs 14.1± 8 months and mean follow up duration of 24.2 ± 5.1 vs 20.7 ±6.0 months respectively (p>0.05). The mean time to return to preinjury activity level was significantly better in IB group compared to MBG group of 12.1 ± 2.3 vs 20.3 ± 3.9 weeks, p <0.001. 55(90.2%) patients in IB and 73(83.7%) in MBG group return to preinjury activity level. Mean postoperative VAS score (1.9± 1.5 vs. 1.7± 1.4, p =0.428), Mean MOxFQ score (19.7± 22.2 vs. 18.2 ± 15.4, p= 0.674) showed no significant difference between MBG and IB group respectively, at final follow up. 

Conclusion: The use of IB augmentation with MBG repair showed a significantly better outcome in terms of early rehabilitation and return to preinjury activity level compared to isolated MBG repair.  However, the functional outcome and VAS score showed no significant difference between the two study groups.