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

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

In this Brostrom repair of the torn ligament on the outside of the ankle, soft, knotless suture anchors will be used so the surgeon does not have to tie any knots. This procedure also uses the InternalBrace technique where, a large flat suture is used to help support the repair during the early phases of healing. This is the anterior talofibular ligament or ATFL for short. It is the torn ligament that needs to be repaired. This video will show the surgery being done on a right foot.

After an incision is made, a drill guide is put on the outer ankle bone, or fibula, to make a pilot hole for the first soft suture anchor. These sutures will be used to repair the ligament. The same steps are repeated for a second suture anchor so that the entire end of the ligament is repaired back to the bone.

These sutures get moved off to the side, and a dissolvable anchor is placed in the talus right next to the ligament's other attachment spot. This anchor secures the large flat suture that will be used for the InternalBrace technique.

Next, the blue suture from the first soft anchor is put through the end of the ligament. The needle is cut off, and the blue end is placed through the loop of the striped suture. Let us take a look and see how this soft, knotless suture anchor works. You can see the blue suture has been passed through the tissue that is going to be repaired to the bone.

The end of the blue suture then gets passed through this loop, and the other end of the striped suture is pulled. This passes the blue suture back through the anchor, which has a little finger trap inside that holds onto the suture. It can be tightened as much as the surgeon wants. These steps are repeated for the second anchor, and here, the ligament itself has been repaired.

The final step is securing the large flat suture for support. A hole is drilled in the tip of the fibula between the two soft anchors. The flat suture is loaded into the tip of another anchor, and the surgeon will measure to make sure it is not too tight or too loose. The last anchor is inserted, and the extra suture is cut off. Here is one final look at the repair.