Review Article| Volume 61, ISSUE 2, P390-395, March 2022

Modified Broström With and Without Suture Tape Augmentation: A Systematic Review

Published:October 16, 2021DOI:


      The Modified Broström has become the gold standard for operative management of chronic lateral ankle instability. Despite overall good clinical outcomes with this procedure, recent biomechanical data have called into question the strength and durability of this technique. Accordingly, the addition of suture tape to the Modified Broström construct has been described in an attempt to more closely recreate the natural biomechanical properties of the ankle lateral ligament complex. We performed a systematic review of the literature was using PubMed, Embase, and CINAHL to identify English-language articles from 2009 to present discussing outcomes with the augmented Modified Broström technique. A total of 4 studies (2 retrospective cohort studies, 2 case series) involving 156 patients with Modified Broström with augmentation met inclusion criteria. Average follow-up time was 13.8 months. Of the 3 studies reporting patient-reported outcome measures both pre- and postoperatively, there was a significant improvement in all measures (p < .05). Two studies compared the Modified Broström directly with and without augmentation, one of which found a statistically significant difference in the Foot and Ankle Ability Measure in favor of the augmentation group (93.1 vs 90.5, p = .027), while American Orthopaedic Foot and Ankle Society score was not significantly different (p > .05) between the 2 procedures across studies. There were no significant differences in complications between techniques. Modified Broström with suture tape augmentation for chronic lateral ankle instability can produce good short-term clinical outcomes with few complications, comparable to the Modified Broström alone.

      Level of Clinical Evidence


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        • Waterman BR
        • Owens BD
        • Davey S
        • Zacchilli MA
        • Belmont Jr., PJ
        The epidemiology of ankle sprains in the United States.
        J Bone Joint Surg Am. 2010; 92: 2279-2284
        • Fong DT
        • Hong Y
        • Chan LK
        • Yung PS
        • Chan KM.
        A systematic review on ankle injury and ankle sprain in sports.
        Sports Med. 2007; 37: 73-94
        • Al-Mohrej OA
        • Al-Kenan i NS
        Chronic ankle instability: current perspectives.
        Avicenna J Med. 2016; 6: 103-108
        • Donovan L
        • Hetzel S
        • Laufenberg CR
        • McGuine TA.
        Prevalence and impact of chronic ankle instability in adolescent athletes.
        Orthop J Sports Med. 2020; 82325967119900962
        • Harrington KD.
        Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability.
        J Bone Joint Surg Am. 1979; 61: 354-361
        • Broström L.
        Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures.
        Acta Chir Scand. 1966; 132: 551-565
        • Gould N
        • Seligson D
        • Gassman J.
        Early and late repair of lateral ligament of the ankle.
        Foot Ankle. 1980; 1: 84-89
        • Scranton Jr., PE
        • McDermott JE
        • Rogers JV
        The relationship between chronic ankle instability and variations in mortise anatomy and impingement spurs.
        Foot Ankle Int. 2000; 21: 657-664
        • Lee KT
        • Park YU
        • Kim JS
        • Kim JB
        • Kim KC
        • Kang SK.
        Long-term results after modified Broström procedure without calcaneofibular ligament reconstruction.
        Foot Ankle Int. 2011; 32: 153-157
        • Bell SJ
        • Mologne TS
        • Sitler DF
        • Cox JS.
        Twenty-six-year results after Broström procedure for chronic lateral ankle instability.
        Am J Sports Med. 2006; 34: 975-978
        • Yeo ED
        • Lee KT
        • Sung IH
        • Lee SG
        • Lee YK.
        Comparison of all-inside arthroscopic and open techniques for the modified Broström procedure for ankle instability.
        Foot Ankle Int. 2016; 37: 1037-1045
        • Waldrop 3rd, NE
        • Wijdicks CA
        • Jansson KS
        • LaPrade RF
        • Clanton TO.
        Anatomic suture anchor versus the Broström technique for anterior talofibular ligament repair: a biomechanical comparison.
        Am J Sports Med. 2012; 40: 2590-2596
        • Schuh R
        • Benca E
        • Willegger M
        • Hirtler L
        • Zandieh S
        • Holinka J
        • Windhager R
        Comparison of Broström technique, suture anchor repair, and tape augmentation for reconstruction of the anterior talofibular ligament.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1101-1107
        • Atkins D
        • Eccles M
        • Flottorp S
        • Guyatt GH
        • Henry D
        • Hill S
        • Liberati A
        • O’Connell D
        • Oxman AD
        • Phillips B
        • Schünemann H
        • Edejer TT
        • Vist GE
        • Williams Jr JW
        Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group.
        BMC Health Serv Res. 2004; 4: 38
        • Brown AJ
        • Shimozono Y
        • Hurley ET
        • Kennedy JG.
        Arthroscopic versus open repair of lateral ankle ligament for chronic lateral ankle instability: a meta-analysis.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 1611-1618
        • Brown AJ
        • Shimozono Y
        • Hurley ET
        • Kennedy JG.
        Arthroscopic repair of lateral ankle ligament for chronic lateral ankle instability: a systematic review.
        Arthroscopy. 2018; 34: 2497-2503
        • Song YJ
        • Hua YH.
        Similar outcomes at early term after arthroscopic or open repair of chronic ankle instability: a systematic review and meta-analysis.
        J Foot Ankle Surg. 2019; 58: 312-319
        • Deeks JJ
        • Higgins JPT
        • Altman DG
        Chapter 10: Analysing data and undertaking meta-analyses.
        in: Higgins JPT Thomas J Chandler J Cumpston M Li T Page MJ Welch VA Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021 (Available at:)
        • Ramirez-Gomez VJ
        • Gomez-Carlin LA
        • Ortega-Orozco R
        • Zazueta-Arnaud CA
        • Patino-Fernandez JP.
        Clinical and functional results of Broström-Gould procedure with suture tape augmentation: an evaluation using three scales.
        J Foot Ankle Surg. 2020; 59: 733-738
        • Xu DL
        • Gan KF
        • Li HJ
        • Zhou SY
        • Lou ZQ
        • Wang Y
        • Li GQ
        • Ruan CY
        • Hu XD
        • Chen YL
        • Ma WH
        Modified Broström repair with and without augmentation using suture tape for chronic lateral ankle instability.
        Orthop Surg. 2019; 11: 671-678
        • Coetzee JC
        • Ellington JK
        • Ronan JA
        • Stone RM.
        Functional results of open Broström ankle ligament repair augmented with a suture tape.
        Foot Ankle Int. 2018; 39: 304-310
        • Yoo JS
        • Yang EA.
        Clinical results of an arthroscopic modified Broström operation with and without an internal brace.
        J Orthop Traumatol. 2016; 17: 353-360
        • Kirk KL
        • Campbell JT
        • Guyton GP
        • Parks BG
        • Schon LC.
        ATFL elongation after Broström procedure: a biomechanical investigation.
        Foot Ankle Int. 2008; 29: 1126-1130
        • Viens NA
        • Wijdicks CA
        • Campbell KJ
        • Laprade RF
        • Clanton TO.
        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: 405-411
        • Sammarco VJ.
        Complications of lateral ankle ligament reconstruction.
        Clin Orthop Relat Res. 2001; 391: 123-132
        • So E
        • Preston N
        • Holmes T.
        Intermediate- to long-term longevity and incidence of revision of the modified Broström-Gould procedure for lateral ankle ligament repair: a systematic review.
        J Foot Ankle Surg. 2017; 56: 1076-1080
        • Brodsky AR
        • O'Malley MJ
        • Bohne WH
        • Deland JA
        • Kennedy JG.
        An analysis of outcome measures following the Broström-Gould procedure for chronic lateral ankle instability.
        Foot Ankle Int. 2005; 26: 816-819
        • Hung M
        • Baumhauer JF
        • Licari FW
        • Voss MW
        • Bounsanga J
        • Saltzman CL.
        PROMIS and FAAM minimal clinically important differences in foot and ankle orthopedics.
        Foot Ankle Int. 2019; 40: 65-73
        • Miyamoto W
        • Takao M
        • Yamada K
        • Matsushita T.
        Accelerated versus traditional rehabilitation after anterior talofibular ligament reconstruction for chronic lateral instability of the ankle in athletes.
        Am J Sports Med. 2014; 42: 1441-1447