Revision Surgery After Broström Repair with Soft End-Point
A soft end-point after Broström repair does not automatically require revision surgery—the decision depends entirely on whether the patient has mechanical symptoms (locking, catching), persistent pain during activities, or swelling that no longer resolves with rest.
Clinical Decision Algorithm
When Revision Surgery is NOT Indicated
Transient, exercise-induced swelling that completely normalizes with rest does not require surgical intervention. 1
- The absence of mechanical symptoms (locking or catching) excludes repair failure, ligament tear extension, or loose bodies that would necessitate revision 1
- Complete normalization after rest distinguishes benign postoperative findings from pathological processes like progressive synovitis or structural complications 1
- A soft end-point alone, without accompanying symptoms, represents normal healing tissue remodeling rather than surgical failure 1
When to Escalate to Revision Surgery
Proceed with revision if any of the following develop:
- Mechanical symptoms emerge (locking, catching, or giving way), which indicate possible repair failure or ligament displacement requiring surgical correction 1
- Pain develops during regular activities or at rest, suggesting inflammatory complications or structural failure beyond normal postoperative recovery 1
- Persistent swelling that no longer resolves with rest, which may indicate synovitis, infection, or other pathological processes requiring intervention 1
Expected Outcomes Without Revision
The modified Broström procedure demonstrates excellent long-term results when properly indicated:
- 94-95% success rates at 2-year follow-up with mean Karlsson scores of 95 ± 3.1, indicating near-complete functional restoration 2
- 86% of patients return to normal or near-normal function on single-leg hop testing (Limb Symmetry Index) 3
- Only 6% major complication rate including reruptures in high-demand athletes, with most patients returning to preinjury activity levels 2
- Zero failures reported in some series with average 64-month follow-up, particularly when proper surgical technique is employed 4
Critical Pitfalls to Avoid
Do not confuse normal postoperative tissue characteristics with surgical failure. A soft end-point immediately post-surgery reflects healing tissue that will mature and strengthen over the rehabilitation period. The key differentiator is symptomatology, not tissue feel alone 1.
Premature revision surgery in asymptomatic patients risks unnecessary morbidity when the original repair would have succeeded with appropriate rehabilitation time 2, 3.