Primary Modified Broström Procedure Shows Superior Outcome to Revision to Lateral Ankle Ligament Reconstruction in Patients With Chronic Lateral Ankle Instability at 5‐Year Follow‐Up

PURPOSE: To compare the mid-term clinical and radiological outcomes of primary modified Broström procedure (MBP) and revision to lateral ankle ligament reconstruction (LALR) in patients with chronic lateral ankle instability. METHODS: We retrospectively reviewed all the patients who underwent primary MBP or revision to LALR between November 2005 and March 2020 with minimum follow-up of more than 5 years. Patients with persistent instability despite of rehabilitations underwent surgery. Propensity score matching (1:4) was designed based on age, sex, and body mass index. Clinical assessments included the visual analog scale for pain, American Orthopaedic Foot and Ankle Society scores, Karlsson-Peterson scores, and Foot and Ankle Outcome Scores. Minimally clinically important difference thresholds for visual analog scale and American Orthopaedic Foot and Ankle Society score were calculated cohort-specifically. Radiographic evaluations included the talar tilt test and the anterior drawer test. Arthroscopic findings and intra-articular pathology were evaluated and recorded. RESULTS: The mean follow-up duration was 107.2 months (range, 60-223). The matched groups showed no significant differences in baseline demographics. There were 663 MBP patients and 44 LALR patients; 176 MBP patients were selected after matching. Intra-articular lesions-synovitis, impingement syndrome, and ossicle formation-were significantly less frequent in the LALR group (P ≤ .042). Preoperative clinical scores were similar between the two groups. However, from 6 months postoperatively, the MBP group had significantly better outcomes in most scores, with more pronounced differences after 1 year. More MBP patients exceeded minimally clinically important difference thresholds than LALR patients for both pain and function (P ≤ .037). There were no significant between-group differences in the radiological outcomes, postoperatively. CONCLUSIONS: Over a 5-year follow-up period, primary MBP produced better pain relief and functional recovery than revision to LALR, despite a higher frequency of intra-articular lesions, with significantly more MBP patients achieving clinically meaningful improvement (minimally clinically important difference). LEVEL OF EVIDENCE: Level III, retrospective comparative case series.