Clinical evaluation of the modified Brostrom-Evans procedure to restore ankle stability

The modified Brostrom procedure has become the standard for anatomic repair of symptomatic chronic lateral instability. However, it was our perception that this local tissue repair may fail eventually, particularly in patient s that are overweight, hyperflexible, or are involved in strenuous work or athletic activity. This is a retrospective review of 21 lateral ankle recon structions (20 patients) in which the modified Brostrom technique was augme nted with a portion of the peroneus brevis tendon. All patients were interviewed at an average of 29.5 months (range, 14-56 mo nths postsurgery), Fourteen patients also agreed to be evaluated by a physi cal therapist. No surgical complications were identified. American Orthopae dic Foot and Ankle Society ankle-hindfoot Scores averaged 98.2, There was n o significant difference in passive or active range of motion of plantarfle xion or dorsiflexion when compared to the contralateral ankle. However, a s tatistically significant loss of inversion (passive, P = 0.011; active, P = 0.018) and eversion (passive, P = 0.004; active, P = 0.007) was noted when compared to the contralateral ankle. Measurement of isometric eversion str ength, using a Cybex 340 Isokinetic device, and functional testing, using a lateral lunge test, revealed no significant loss of peroneal strength. The authors conclude that chronic lateral ankle instability in the general population can be successfully managed with a modified Brostrom procedure a ugmented with a portion of the peroneus brevis. The procedure remains techn ically simple and provides a greater static restraint for inversion stress without evidence of dramatic overtightening or loss of peroneal strength.