Is the Broström (Broström‑Gould) ankle ligament repair structurally sound?

Structural Integrity of the Broström Repair

The Broström (Broström-Gould) repair is structurally sound and demonstrates excellent anatomic healing with maintained ligament integrity on MRI evaluation, producing favorable clinical outcomes and low failure rates of approximately 6% when performed with modern suture anchor fixation techniques. 1, 2

MRI Evidence of Structural Integrity

Anatomic healing and structural soundness are confirmed by postoperative MRI findings:

• MRI demonstrates intact anterior talofibular and calcaneofibular ligaments with continuous fiber integrity after Broström repair, confirming successful anatomic reconstruction 1
• The repaired ATFL shows an average length of 18.6 ± 4.3 mm and width of 3.6 ± 0.9 mm on postoperative imaging, indicating appropriate anatomic restoration 3
• Increased signal and caliber within repaired ligaments represent expected postoperative remodeling changes rather than structural failure 1
• Clear differentiation between the native ligament and augmentation device (when used) can be demonstrated in 87.5% of cases (28/32 patients), confirming preserved anatomic planes 3

Clinical Outcomes Demonstrating Structural Soundness

The repair produces consistently strong functional results:

• AOFAS scores average 94.3 to 94.4 points postoperatively, indicating excellent restoration of ankle function 3, 4
• Return to sport occurs at an average of 84.1 days (approximately 12 weeks), with a 94% return-to-sport rate 2, 4
• The single-leg hop test shows 86.4% of patients return to normal or near-normal function, objectively confirming structural stability 4
• 95% of patients achieve excellent or good functional outcomes by the Sefton assessment system at mid-term follow-up 5

Failure Rates and Structural Durability

The repair demonstrates low failure rates across multiple studies:

• Failure rate of 6% with only 3 patients reporting residual instability after traumatic re-tear in a series of 49 patients at mean 42-month follow-up 2
• Stress radiography confirms structural restoration: talar tilt reduces from 13.9° ± 2.4° preoperatively to 3.8° ± 1.8° postoperatively 5
• Anterior drawer displacement improves from 9.6 ± 2.9 mm to 2.3 ± 1.6 mm, demonstrating mechanical stability 5

Augmentation Enhances Structural Integrity

When augmented with suture tape (InternalBrace™), the repair shows additional structural benefits:

• Augmentation allows immediate protected full weight-bearing from postoperative day one without compromising structural integrity 2
• The augmentation device maintains good integrity on MRI evaluation at 12-18 months, with no correlation between bone marrow edema and device tension 3
• Augmented repairs produce favorable outcomes with no tendency for the repair to stretch during accelerated rehabilitation 4

Technical Factors Supporting Structural Soundness

Modern fixation techniques enhance repair strength:

• Suture anchor fixation (typically two 3.5-mm double-loaded anchors) provides secure anatomic advancement of the ATFL and CFL to the fibula 2
• Transosseous fixation through fibular bone tunnels represents a viable alternative that produces excellent mid-term results 5
• The repair restores anatomy and kinematics of the joint, which is critical for long-term structural integrity 2

Common Pitfalls in Assessing Structural Integrity

Avoid misinterpreting normal postoperative findings as failure:

• Suture artifact and mild inhomogeneity within repaired ligaments are normal MRI findings and do not indicate structural compromise 1
• Increased signal intensity in the repaired ligament should not be mistaken for re-injury when fiber continuity is maintained 1
• Repeat surgery is only indicated if frank instability develops, demonstrated by a positive anterior drawer test at 4-5 days post-injury (sensitivity 84%, specificity 96%) 1

Safety Profile

The procedure demonstrates a favorable safety profile:

• No instances of structural injury to peroneal tendons, superficial peroneal nerve, or sural nerve when proper portal placement is used (accessory lateral portal 1.5 cm anterior to fibular tip) 6
• Complication rates are low, with only 2 cases of superficial wound infection and 1 case of temporary neurapraxia reported in a series of 49 patients 2
• No significant difference in range of motion compared to the contralateral side postoperatively (P = 0.34 for overall motion, P = 0.506 for plantar flexion) 2, 4