Chronic Ankle Sprains (Lateral Ankle Instability): Brostrom Repair With Suture Augmentation Procedure

Chronic Ankle Sprains (Lateral Ankle Instability): Broström Repair With Suture Augmentation Procedure

To begin the Broström repair on this patient, the surgeon makes the skin incision over the repair site. They will slowly work through the soft tissue to get down to the ligament that needs to be repaired. The surgeon will then use this guide to drill a pin into the talus. This is where the first anchor will go for the repair. They will use x-ray to make sure the pin is in the right spot.

Next, they will place a drill over the pin to make the hole the right size for the anchor. The anchor gets inserted into the hole. You can see a blue flat suture that is already loaded into the tip of the anchor. This blue flat suture gets secured in the bone by the anchor and will be used to help support the ligament repair during the early phases of healing. When these 2 black lines are even, the anchor is all the way in. The inserter shaft is removed, and the sutures are moved off to the side.

Here is the ligament that will be repaired. The surgeon will then turn their attention to the fibula where the ligament will be attached to. They will insert 2 suture anchors that will bring the ligament down to the bone.

Let us review what each of these anchors will be doing. The first anchor that was placed is here on the talus. It has the blue flat suture attached to it that is pulled off to the side here. The 2 knotless anchors that the surgeon just inserted are here and here. These will hold the ligament back down to the fibula while it heals. This last anchor secures the blue flat suture across the repair for support. The surgeon is now drilling a hole for that last anchor, which we will use at a later step.

The next step here is to pass the blue repair sutures from the knotless anchors through the ligament. The blue repair suture from the first anchor gets put through the ligament. The needle then gets cut off and the blue repair suture gets put through the white shuttle suture. This will bring the blue repair suture back down through the anchor, making the repair nice and tight without any knots. The surgeon can pull until they get the right amount of tension.

The same steps are repeated for the second anchor. Again, the blue repair suture is through the tissue and gets shuttled back down through the anchor, bringing the tissue back down to the bone. The extra suture tails are cut.

The only step left is to secure the blue flat suture to support the repair. Since the hole for this anchor was already drilled, the surgeon simply feeds the blue flat suture through the tip of the anchor to get ready to place it. The surgeon will measure the flat suture to make sure it is not too tight or too loose. After tapping in the anchor, the inserter is removed and the extra suture is cut.

The entire repair was completed without having to tie any knots. All of the soft tissue and skin will be closed and the patient will start their road to recovery.