Long-term revision-free survival after unaugmented modified Broström repair for chronic lateral ankle instability: A single tertiary-centre series of 110 ankles
This single-center study of 110 ankles demonstrates that the unaugmented modified Broström repair provides durable long-term stability with a 96.1% revision-free survival rate at 10 years, as subsequent surgeries were primarily driven by degenerative or adjacent-joint pathology rather than repair failure.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The ankle is a deceptively simple hinge, yet it bears the complex burden of our entire body weight with every step we take. When the ligaments that hold this joint together are repeatedly stretched or torn, the ankle can lose its ability to stay stable, leading to a condition known as chronic lateral instability. Patients with this problem often feel a recurring sense of the foot giving way, a sensation that makes walking on uneven ground or even standing still feel precarious. While physical therapy and bracing are the first line of defense, they do not work for everyone. When these non-surgical measures fail, surgeons often turn to a specific operation called the modified Broström repair. This procedure involves taking the loose, stretched ligaments and tightening them back to their original position on the bone, essentially restoring the ankle's natural tension without adding foreign materials.
For years, a quiet debate has persisted among surgeons regarding whether this repair needs extra reinforcement. Some argue that adding a synthetic tape or graft to the repair acts as a safety net, potentially allowing patients to recover faster and protecting the joint in those with very loose ligaments or specific bone alignments. Others believe that a skillfully performed repair using only the patient's own tissue is strong enough on its own, avoiding the cost and potential risks of implants. The core of the disagreement lies in a lack of long-term evidence; most studies have only tracked patients for a few years, leaving the question of whether the repair holds up over a decade unanswered.
A team of researchers at a major medical center in Scotland set out to resolve this uncertainty by looking back at a large group of patients who underwent the repair without any added reinforcement. They examined the records of 110 ankles treated between 2013 and 2025, following these patients for as long as thirteen years. Their primary goal was to see how many of these ankles eventually required a second surgery specifically because the original repair had failed and the ankle had become unstable again. They also tracked any other surgeries performed on the same ankle, regardless of the reason, to get a complete picture of the joint's long-term health.
The results of this long-term review offer a clear answer to the question of durability. Out of the 110 ankles studied, only four required a revision surgery to fix recurrent instability. Crucially, none of these failures happened after the first three and a half years. This means that for the vast majority of patients, the repair remained solid for the long haul. The researchers calculated that ten years after the operation, approximately 96 percent of the ankles had remained free from the need for a revision due to instability. This high success rate suggests that the un-augmented repair is a reliable, durable solution that does not necessarily require extra reinforcement to last.
However, the story of the ankle's future is not entirely about the success of the repair itself. While the ligaments held firm, the researchers found that some patients did require further surgery on the same ankle for other reasons. By the ten-year mark, about 81 percent of the ankles had avoided any additional surgery of any kind. The surgeries that did occur were rarely due to the repair failing; instead, they were mostly performed to address wear-and-tear arthritis or problems in the joints next to the ankle. This distinction is vital for understanding the outcome: the repair itself is rarely the weak link, but an ankle that has suffered enough instability to need surgery may still develop age-related or injury-related joint disease over time.
The study also looked at the safety of the procedure. While complications occurred in about one-third of the cases, the vast majority were minor issues such as temporary numbness or slight wound irritation. Serious problems like deep infections or permanent nerve damage were extremely rare. The researchers noted that the patients' foot alignment, such as whether their heel turned inward or outward, did not seem to change the likelihood of the repair failing, though the number of such cases was too small to be certain.
Ultimately, this long-term look at the un-augmented modified Broström repair provides strong evidence that the technique is robust. It demonstrates that for patients with chronic ankle instability, a well-executed repair using only their own tissue can provide a decade of stability without the need for synthetic aids. While the ankle may still face challenges from arthritis or other joint issues later in life, the repair itself stands as a durable foundation, suggesting that the added complexity and cost of reinforcement may not be necessary for most patients seeking a long-term solution.
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