Modified Brostrom with and without Suture Tape Augmentation: A Systematic Review

CATEGORY: Ankle; Sports INTRODUCTION/PURPOSE: The Modified Brostrom (MB) has become the gold standard for operative management of chronic lateral ankle instability. Despite overall good clinical outcomes with this procedure, recent biomechanical data has called into question the strength and durability of this technique. Accordingly, the addition of suture tape to the MB construct has been described in an attempt to more closely recreate the natural biomechanical properties of the ankle lateral ligament complex. Despite its increasing popularity, the Modified Brostrom with suture tape augmentation (MBA) remains controversial due to a lack of clinical data. The purpose of this study is to determine the differences in clinical outcomes of MB compared to MBA. METHODS: A systematic review of the literature was performed using PubMed, Embase, and CINAHL to identify English-language articles from 2009 - present discussing outcomes with the MBA technique. Total number of patients, patient demographics, follow-up time, subjective and objective outcome measures, return to sport, recurrent instability, and complications were evaluated. RESULTS: A total of 4 studies (2 retrospective cohort studies, 2 case series) involving 156 patients with MBA met inclusion criteria. Average follow-up time was 13.8 months. Of the 3 studies reporting patient-reported outcome measures both pre-and post- operatively, there was a significant improvement in all measures (p<0.05). Two studies compared MB directly to MBA, one of which found a statistically significant difference in the Foot and Ankle Ability Measure (FAAM) in favor of the MBA (93.1 vs 90.5, p=0.027), while American Orthopaedic Foot & Ankle Society (AOFAS) score was not significantly different (p>0.05) between MB and MBA across studies. One study reported a significantly greater rate of return to sport at 12 weeks in the MBA group versus the MB (82% vs 27%, p<.001). There were no significant differences in complications between MB and MBA. CONCLUSION: MBA for chronic lateral ankle instability can produce good short-term clinical outcomes with few complications, comparable to MB. The overall quality of evidence is low, and long-term, prospective, head-to-head comparison data will be needed to determine the clinical efficacy, complication profile, and cost-benefit relationship of the MBA technique as it compares to the MB.