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Broström With Augmentation Markedly Improves Ankle Stability Measured by the Cumberland Ankle Instability Tool Compared With Broström Without Augmentation.

Steven M. Hadley,Rachel Bergman,Sarah J. Westvold,Tanya Kukreja,Ryan Filler,A. Kadakia

Published 2025 in Journal of the American Academy of Orthopaedic Surgeons

ABSTRACT

BACKGROUND Limited data exist regarding whether Broström with InternalBrace augmentation bolsters ankle stability compared with nonaugmented Broström. Our study aims to determine whether augmented Broström produces greater stability measured by Cumberland Ankle Instability Tool (CAIT). METHODS All patients who underwent lateral ankle ligament reconstruction at a single institution (2013 to 2024) were retrospectively reviewed by two independent investigators. Revisions, allografts, nonanatomic reconstructions, flexor digitorum longus transfers, progressive collapsing foot deformities, concomitant hindfoot arthrodesis, associated ankle arthroplasties, concomitant fractures, and those who did not have both preoperative and postoperative CAIT were excluded. A total of 127 patients meeting eligibility criteria were contacted to complete postoperative surveys assessing CAIT. Student t-tests and Pearson Chi-squared test were used for unadjusted comparisons. Linear regression compared mean postoperative CAIT by procedure type, controlling for preoperative CAIT and clinically relevant covariates. Preoperative CAIT was included as an interaction term with Broström type to assess whether the effect of surgery varied by baseline instability. Post hoc analyses were conducted to calculate estimated marginal means (EMMs) and assess between-group differences at the 25th, 50th, and 75th percentiles of preoperative CAIT. RESULTS In unadjusted comparisons, patients who received InternalBrace augmentation (n = 80), had significantly higher postoperative CAIT (20.6 ± 8.2 vs. 16.5 ± 10.5; P = 0.02) compared with nonaugmented (n = 47). In analyses adjusted for preoperative CAIT, augmented was associated with 7.13-point higher postoperative score (P < 0.01). Post hoc analyses of EMMs revealed that at preoperative CAIT = 2 (25th percentile), augmentation was associated with significantly higher postoperative CAIT (EMM = 20.3; 95% CI, 15.3-25.2; mean difference = 5.98; P < 0.01). At preoperative CAIT = 7 (median), the between-group difference was smaller and no longer significant, although augmented still trended toward higher scores (mean difference = 3.10; P = 0.07). CONCLUSIONS Broström with InternalBrace augmentation may generate improved ankle stability measured by CAIT compared with nonaugmented Broström. The benefit of augmentation is most pronounced in patients with high preoperative ankle instability.

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