A prospective comparative study of arthroscopic Brostrom procedure alone vs. Brostrom-Gould procedure in the repair of isolated ATFL injury at follow-up in one year

OBJECTIVES: Arthroscopic Brostrom-Gould procedure is the reference technique in the treatment of isolated anterior talofibular ligament injury. Extensor retinaculum reinforcement uses the proximal part, without any mechanical function. The objective is to compare the isolated ATFL reinsertion technique with reinsertion + biological augmentation. METHODS: This is a prospective study that compares the isolated ATFL reinsertion technique (Brostrom) vs. reinsertion + retinaculum reinforcement (Brostrom-Gould) at one year follow-up. 2 groups of 25 patients were selected. The two groups matched in terms of age, weight, and gender. All patients presented with isolated ATFL with stage 1 or 2 lesions according to the French arthroscopy society (SFA) classification. Patients were clinically evaluated preoperative and in one year with the FAAM and FAOS scores and the recurrence rate was assessed as well as passive joint amplitudes pre- and postoperatively. There was a single operator for the series and the surgical technique was chosen before surgery. Patients had the same postoperative rehabilitation protocol (ankle splint to be worn for 30 days with weight-bearing, no work in varus before 30 days, rehabilitation at D2). RESULTS: Regarding clinical scores, in both groups there was a significant improvement in the sports FAAM and FAOS scores in the postoperative period. In the isolated Brostrom group, the FAAM score increased from 20 to 29 and the FAOS score from 75% to 95%. In the Brostrom-Gould group, the FAAM score increased from 19 to 30 and the FAOS score from 77% to 96%. There was no significant difference between the 2 groups. We identified no postoperative complications in either group. A sprain recurred in 2 patients in the Brostrom-Gould group and in 3 patients in the isolated Brostrom group. The sprain was mild in all cases and was controlled by ultrasound. The joint amplitudes in active plantar flexion were 36° in the isolated Brostrom group and 34° in the Brostrom-Gould group. There was no significant difference between the 2 groups. CONCLUSION: Our study shows that there is no difference between the isolated arthroscopic Brostrom technique and the Brostrom-Gould technique in the management of isolated ATFL grade 1 and 2 lesions in terms of recurrence and clinical scores and that the isolated Brostrom technique can be used to treat these lesions.