July 2012

ATFL repair with any of three methods decreases ligament stiffness, strength

In the moment: Ankle

By Jordana Bieze Foster

Three different methods for repairing the anterior talofibular ligament (ATFL) leave the repaired structure significantly stiffer and weaker than an intact ligament, which may have implications for ankle injury rehabilitation, according to research presented in June at the AOFAS meeting.

Investigators from the Steadman Clinic in Vail, CO, compared the traditional Bro­strom procedure and two suture-anchor modifications of that procedure in 18 cadaveric models of an ATFL rupture; six additional cadaver ankles were left intact. The suture anchor fibula and suture anchor talus modifications both resulted in ligament failure loads and stiffness levels that were similar to those associated with the traditional Bro­strom procedure.

However, ligaments repaired using any of the three techniques had only about half the strength and stiffness of the intact ligaments.

“With modern rehabilitation protocols emphasizing early weightbearing and motion, there may be cause for concern,” said Norman E. Waldrop III, MD, an orthopedic surgery foot and ankle fellow at the clinic, who presented the findings at the AOFAS meeting.

Waldrop NE III, Wijdicks C, Jansson K, et al. Anatomic suture anchor versus the Brostrom technique for anterior talofibular ligament repair: A bio­mechan­ical comparison. Presented at the American Orthopaedic Foot & Ankle Society Annual Meeting, San Diego, June 2012.

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