BroströM Procedure Presentation

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BroströM Procedure Presentation

  1. 1. The Modified Broström Procedure Indications and surgical outline in the candidate patient
  2. 2. The Modified Broström Procedure An unstable ankle is usually classified as grade I, II, or III, depending upon the amount of instability p A grade I ankle has a barely detectable drawer sign and a normal talar tilt p A grade II ankle has a moderate drawer sign and a talar tilt of 10 to 15 degrees from normal p A grade III ankle has a markedly positive drawer sign and a talar tilt of 15 to 25 degrees.
  3. 3. The Modified Broström Procedure p Almost all grade I ankles and about half of grade II ankles will do well with conservative therapy p Grade III ankles will do poorly without surgery, because the instability is too great for the peroneal tendons to control, no matter how strong they may be p Surgical reconstruction of the ligaments should of course be a last resort, but addressed if chronic and symptomatic p Unrecognized peroneal tendon weakness is very common in dancers and athletes with ankle instability p Detecting and correcting this weakness is an important first step in treatment, as many grade I and II instabilities can be brought under control by exercises alone p No patient should be considered for ligament reconstruction unless full achievable peroneal strength has been restored and the patient remains symptomatic
  4. 4. The Modified Broström Procedure p Proprioceptive deficits are always present due to stretching of capsule p Such deficits should be corrected, if possible, with therapy that includes tilt boards and resuming use of the ankle when strength permits p Non-surgical treatment for this patient's problem would include taping or bracing, as well as physical therapy to correct the weakness and lack of proprioception p If bracing is also ineffective in stabilizing the ankle and… p Physical therapy in this case has been tried and has failed… p Anatomic repair is the next best choice, but only if the anterior talo/fibular ligament is torn p If the calcanealfibular ligament is torn, a transfer is indicated p If the injury is many months old, there will be no vestige of the anterior talo/fibular ligament and anatomic repair will be impossible
  5. 5. The Modified Broström Procedure p A surgical procedure is needed that will restore stability and proprioception, preserve the peroneal tendons and leave the patient with full plantarflexion and full dorsiflexion p The procedure that fulfills these requirements is the Broström procedure, as modified by Gould et al p Gould’s modification was to pull up the adjacent extensor retinaculum and attach it to the tip of the fibula at the end of the procedure p This reinforces the repaired ligaments, limits adduction, supination and inversion and corrects the subtalar component of the instability
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  24. 24. The Modified Broström Procedure pAfter closure, the ankle’s stability is tested one last time to assure proper strength and reduction of the anatomic ligaments. pOnce subcuticular closure is done, splinting of the extremity is applied. This splint is worn for one week before the 1st post-op check. Dressings are changed and splint is reapplied for another week. pAt the 2-week time period, PT is employed to begin basic range-of-motion exercises. pAt this time, a cam-walker is used on the foot for weight- bearing. pAfter4-6 weeks, full ROM exercises are used in PT. pNormal activities are allowed at 8 weeks with restrictions on athletic participation.
  25. 25. The Modified Broström Procedure pLess invasive than a tendon transfer pAllows normal ROM after recovery as this is an anatomic repair, as opposed to the Christman-Snook or Elmslie, etc pPatients must not have advanced osteoarthritic changes to the ankle or sub-talar joint pPeroneal weakness/muscle disease--i.e., Charcot- Marie-Tooth--or complete dissolution of the ATF/CF ligaments are a contra-indication

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