Suture-Anchor Broström–Gould repair with fibular periosteal flap augmentation for chronic lateral ankle instability: a North African experience

Abstract Ankle sprains are a common musculoskeletal injury, accounting for up to 20%. Although most of these injuries are initially treated nonoperatively, a subset of patients develops chronic lateral ankle instability (CLAI) over time, which, if symptomatic, will require operative intervention. To report our early results from a specialized North African sports medicine surgery unit after performing a modified Broström–Gould procedure using a suture anchor and augmenting the repair using a distally based fibular periosteal flap. Twenty-two patients, with a mean age of 33.48 ± 8.23 years, including 10 (45.45%) males and 12 (54.55%) females, presented with CLAI and were treated with the modified Broström–Gould procedure. The mean follow up was 29.3 ± 7.18 months, and the clinical assessment included the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scale (VAS) for pain. Any complications were reported. The mean operative time was 61.3 ± 11.15 min. Two (9.1%) patients had complications: one with a superficial surgical site infection and the other with superficial peroneal nerve neuropraxia; both were treated conservatively. The AOFAS improved significantly at the last follow up compared to the preoperative scores, 83.9 ± 10.73 vs. 57.1 ± 14.78, respectively (p < 0.01). The VAS score improved significantly from a preoperative median of 7 to a last follow up median of 2 (p < 0.01). The patients returned to their activities of daily living after a mean of 13.30 ± 2.38 weeks. The majority of patients (95.5%) were either very satisfied or satisfied with the outcomes. None of the patients had instability recurrence or required secondary surgical intervention. Using suture anchors for ligament reattachment and augmenting the repair with a distally based fibular periosteal flap as a modification to the Broström–Gould procedure for managing CLAI demonstrated efficacy and acceptable clinical and patient satisfaction outcomes. Furthermore, despite a relatively high complication rate, it was consistent with the literature. However, future comparative studies are warranted to validate the obtained results.