Broström-Gould Procedure: 5-Year Follow-Up

Ankle sprains are a common musculoskeletal injury among the general population and often involve the lateral ligament complex. Although the majority of ankle sprains are treated successfully with nonsurgical conservative measures, an estimated 5% to 20% of ankle injuries ultimately develop chronic lateral ankle instability (CAI). Multiple surgical treatment modalities for the lateral ankle complex exist, such as anatomical and non-anatomical reconstruction. The current gold standard for primary surgical repair is the Broström-Gould (BG) procedure. This is the first article to provide PROMIS scores following BG and the largest study with 5-year outcomes for an open BG. (PROMIS, Patient-Reported Outcomes Measurement Information System.)

This was a descriptive study of a retrospective cohort of patients undergoing a BG with a minimum follow-up of 5 years. Patient-reported outcome instruments collected postoperatively were PROMIS Pain, Physical Function, Depression, and Foot and Ankle Ability Measure (FAAM). Further preoperative clinic characteristics were analyzed to correlate with the final outcome. The electronic medical record was queried for Current Procedural Terminology (CPT) code 27698 (Broström-Gould) from January 2010 to June 2017. Surveys were conducted in the clinic and through phone interviews. Patient charts were reviewed to obtain basic patient demographic information including sex, age, race, and body mass index (BMI). The following preoperative variables were recorded: history of prior CAI procedures, history of major trauma, duration of symptoms, number of diagnosed ankle sprains, other collagen pathologies, generalized ligament laxity, participation in sports/activity level, peroneal subluxation, clinically diagnosed peroneus longus or brevis tendinopathy, deltoid ligament injury, anterior ankle impingement, and posterior ankle impingement. The PROMIS and FAAM scores were obtained with a combination of clinic and phone interviews. Data were aggregated in Microsoft Excel and entered in R (version 4.2.0) for statistical analysis.

Results show that the minimum 5-year patient-reported PROMIS scores for patients following a Broström-Gould procedure are as follows: PROMIS physical function, 50.5; PROMIS pain interfnce, 48.2; and PROMIS depression, 38.2. This indicates, at a minimum, that patients 5 years removed from the procedure are within 1 standard deviation (SD) of the general population in regard to PROMIS physical function and pain. The patient-reported FAAM, activities of daily living, and FAAM sports scores were 59.6 and 13.0, respectively. Linear regression to understand the factors significantly impacting patient reported outcomes are seen in the Table. The following variables were statistically significant: FAAM score peroneal tenodesis, FAAM ADL tobacco use, PROMIS PF age > 50, PROMIS PI tobacco use, diabetes, participate in sports activities, PROMIS depression age > 50, history of major trauma, varus stress test, and tobacco use.

Preoperative magnetic resonance imaging (MRI) findings were recorded. Arthroscopic examination was performed before lateral ligaments reconstruction for patients with intra-articular pathologies confirmed on MRI.

These findings offer evidence supporting the effectiveness of the Broström-Gould procedure to be associated with normal physical function, even 5 years after surgery. Furthermore, this research identified specific factors such as tobacco use, diabetes, and sports participation that independently correlated with reported outcome measures. These insights enable physicians to better manage patient expectations and tailor treatment strategies accordingly. This study establishes a foundation for future prospective research endeavors that aim to leverage the PROMIS system for comprehensive outcome assessments.

Source: Scheinberg M, Sanchez T, Sankey T, et al. Patient-Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5-Year Follow-Up. Foot Ankle Orthop. 2024;9(1):24730114241228272. doi: 10.1177/24730114241228272. Use if per CC BY 4.0.