TY - JOUR
T1 - ArthroBroström Lateral Ankle Stabilization Technique
AU - Acevedo, Jorge I.
AU - Ortiz, Cristian
AU - Golano, Pau
AU - Nery, Caio
N1 - Publisher Copyright:
© 2015 The Author(s).
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Background: Arthroscopic ankle lateral ligament repair techniques have recently been developed and biomechanically as well as clinically validated. Although there has been 1 anatomic study relating suture and anchor proximity to anatomic structures, none has evaluated the ArthroBroström procedure. Purpose: To evaluate the proximity of anatomic structures for the ArthroBroström lateral ankle ligament stabilization technique and to define ideal landmarks and "safe zones" for this repair. Study Design: Descriptive laboratory study. Methods: Ten human cadaveric ankle specimens (5 matched pairs) were screened for the study. All specimens underwent arthroscopic lateral ligament repair according to the previously described ArthroBroström technique with 2 suture anchors in the fibula. Three cadaveric specimens were used to test the protocol, and 7 were dissected to determine the proximity of anatomic structures. Several distances were measured, including those of different anatomic structures to the suture knots, to determine the "safe zones." Measurements were obtained by 2 separate observers, and statistical analysis was performed. Results: None of the specimens revealed entrapment by either of the suture knots of the critical anatomic structures, including the superficial peroneal nerve (SPN), sural nerve, peroneus tertius tendon, peroneus brevis tendon, or peroneus longus tendon. The internervous safe zone between the intermediate branch of the SPN and sural nerve was a mean of 51 mm (range, 39-64 mm). The intertendinous safe zone between the peroneus tertius and peroneus brevis was a mean of 43 mm (range, 37-49 mm). On average, a 20-mm (range, 8-36 mm) safe distance was maintained from the most medial suture to the intermediate branch of the SPN. The amount of inferior extensor retinaculum (IER) grasped by either suture knot varied from 0 to 12 mm, with 86% of repairs including the retinaculum. Conclusion: The results indicate that there is a relatively wide internervous and intertendinous safe zone when performing the ArthroBroström technique for lateral ankle stabilization. While none of the critical anatomic structures was entrapped by the suture knots, it was evident that the IER was included in a majority of the repairs. This study further defines the proximity of adjacent anatomic structures and establishes the anatomic safe zones for the ArthroBroström lateral ankle stabilization procedure. Clinical Relevance: By defining this relatively risk-free zone, surgeons who are not as experienced with arthroscopic lateral ligament repair techniques may approach arthroscopic suture passage with more confidence.
AB - Background: Arthroscopic ankle lateral ligament repair techniques have recently been developed and biomechanically as well as clinically validated. Although there has been 1 anatomic study relating suture and anchor proximity to anatomic structures, none has evaluated the ArthroBroström procedure. Purpose: To evaluate the proximity of anatomic structures for the ArthroBroström lateral ankle ligament stabilization technique and to define ideal landmarks and "safe zones" for this repair. Study Design: Descriptive laboratory study. Methods: Ten human cadaveric ankle specimens (5 matched pairs) were screened for the study. All specimens underwent arthroscopic lateral ligament repair according to the previously described ArthroBroström technique with 2 suture anchors in the fibula. Three cadaveric specimens were used to test the protocol, and 7 were dissected to determine the proximity of anatomic structures. Several distances were measured, including those of different anatomic structures to the suture knots, to determine the "safe zones." Measurements were obtained by 2 separate observers, and statistical analysis was performed. Results: None of the specimens revealed entrapment by either of the suture knots of the critical anatomic structures, including the superficial peroneal nerve (SPN), sural nerve, peroneus tertius tendon, peroneus brevis tendon, or peroneus longus tendon. The internervous safe zone between the intermediate branch of the SPN and sural nerve was a mean of 51 mm (range, 39-64 mm). The intertendinous safe zone between the peroneus tertius and peroneus brevis was a mean of 43 mm (range, 37-49 mm). On average, a 20-mm (range, 8-36 mm) safe distance was maintained from the most medial suture to the intermediate branch of the SPN. The amount of inferior extensor retinaculum (IER) grasped by either suture knot varied from 0 to 12 mm, with 86% of repairs including the retinaculum. Conclusion: The results indicate that there is a relatively wide internervous and intertendinous safe zone when performing the ArthroBroström technique for lateral ankle stabilization. While none of the critical anatomic structures was entrapped by the suture knots, it was evident that the IER was included in a majority of the repairs. This study further defines the proximity of adjacent anatomic structures and establishes the anatomic safe zones for the ArthroBroström lateral ankle stabilization procedure. Clinical Relevance: By defining this relatively risk-free zone, surgeons who are not as experienced with arthroscopic lateral ligament repair techniques may approach arthroscopic suture passage with more confidence.
KW - Broström repair
KW - ankle
KW - arthroscopic ankle lateral ligament repair
KW - ligaments
UR - http://www.scopus.com/inward/record.url?scp=84942924658&partnerID=8YFLogxK
U2 - 10.1177/0363546515597464
DO - 10.1177/0363546515597464
M3 - Article
C2 - 26306779
AN - SCOPUS:84942924658
SN - 0363-5465
VL - 43
SP - 2564
EP - 2571
JO - American Journal of Sports Medicine
JF - American Journal of Sports Medicine
IS - 10
ER -