- 1/10,000 persons/day
- 23,000 ankle sprains in the U.S. each day
- 40-45% of sports injuries are ankle injuries
- 85% of ankle injuries are sprains
- 85% of sprains are due to inversion with injury to the lateral ligaments
February 8, 2018]. Foot Ankle Int. doi:10.1177/1071100717742363.
- Six to 24-month follow-up of 81 patients with a Broström and InternalBrace ligament augmentation
- InternalBrace ligament augmentation shows accelerated rehabilitation and mean return to sport
of 12 weeks (3 months) and average time to full weightbearing of 16 days (range, 1-64 days)
- Motivated athletes were able to return to play, some as early as 8 weeks after surgery
- Ankle joint mechanics (dorsiflexion and plantarflexion) comparison between operative and contralateral sides showed no major differences
- Highlights limitations of standard Broström repair where ankle is often immobilized for 6 weeks before rehabilitation starts and usually takes 4-6 months before athlete can return to pla
Isolated anterior talofibular ligament Broström repair for chronic lateral ankle instability: 9-year follow-up.
Am J Sports Med. 2013;41(4):858-864. doi:10.1177/0363546512474967.
- “All my Brostroms do well”… or do they?
- 9-year follow-up of 42 athletes who had ankle ATFL Brostrom repair
– 58% returned to preinjury level of activity, 16% returned to a lower level of activity, 26%
abandoned athletic activity
– In addition to 42% stepping down or abandoning activity, of the patients who had no evidence of
degenerative changes preoperatively, 30% had radiographic signs of degenerative changes of the ankle at 9 years
Anterior talofibular ligament ruptures, part 1: biomechanical comparison of augmented Broström repair
techniques with the intact anterior talofibular ligament. Am J Sports Med. 2014;42(2):405-411.
- ATFL InternalBrace ligament augmentation cadaveric biomechanical study testing ultimate load
of failure at time 0
- Broström and InternalBrace ligament augmentation = ~250 N
- ATFL InternalBrace ligament augmentation is stronger and as stiff as the native ATFL at time 0
- “Adding strength to Broström is valuable in patients with generalized ligamentous laxity, in large
patients or elite athletes, or when allograft tenodesis reconstruction is not feasible”
ATFL elongation after Brostrom procedure: a biomechanical investigation. Foot Ankle Int. 2008;29(11):1126-1130. doi:10.3113/FAI.2008.1126. Foot & Ankle International, Vol. 29 #11, Nov. 2008
- (Human cadaveric study) Unprotected motion associated with significant lengthening of ligament after ATFL repair
- Conclusion: Need to protect the ATFL and cast during conservative rehab
A review of ligament augmentation with the InternalBrace™: the surgical principle is described for the lateral
ankle ligament and ACL repair in particular, and a comprehensive review of other surgical applications and
techniques is presented. Surg Technol Int. 2015;26:239-255.Supports early mobilization of repaired ligament
with minimal surgical morbidity
- Review of ligament reconstruction techniques and highlight of the application of InternalBrace
ligament augmentation for ATFL Broström and ACL
- Highlights change in orthopedics from reconstruction with allograft or autograft to restoration
of normal anatomy with InternalBrace ligament augmentation
Open modified Broström ankle reconstruction with internal brace augmentation: a novel approach.
Orthopedics Today. 2015;35(8):28.
- Novel surgical technique overview of Arthrex InternalBrace ligament augmentation repair
to augment modified Broström
- Discusses how “increased construct strength allows the surgeon to consider implementation of an accelerated rehabilitation program, earlier return to activity and decreased recurrent instability”
Stabilizing the lateral ankle via a Brostrom repair with suture tape augmentation. Podiatry Today. 2015;28(5).
- The technique increases the strength of the repair
- Suture tape augmentation serves to protect the repair and allows for earlier rehabilitation.
Effects of immobilization on joints. Clin Orthop Relat Res. 1987;(219):28-37.
Clinical Orthopaedic & Related Research, Volume 219, June 1987
- Direct negative effects on joint mechanics and muscle atrophy
- Diminished proprioception (the ability to sense stimuli arising within the body regarding position, motion, and equilibrium)
- Casting negatively affects ligaments
Arthrex, Inc. LA1-0408-EN_A. Naples, FL; 2014.
- ATFL InternalBrace ligament augmentation with all 4 constructs of 3.5 mm and 4.75 mm
BioComposite SwiveLock® anchors tested
- All above 150 N (native strength) and range from 181-352 N