Outcomes of Revision Modified Broström Procedure with Periosteal Flap Augmentation in Patients with Recurrent Chronic Ankle Instability.

BACKGROUND

Although the modified Broström procedure (MBP) is widely accepted as the standard surgical treatment for chronic ankle instability (CAI), recurrent instability remains a clinical challenge, particularly in patients with poor tissue quality or high functional demands. To overcome these limitations, periosteal flap augmentation has been proposed as a biological alternative for patients with recurrent CAI after failed MBP. This study evaluated the clinical and radiographic outcomes of revision MBP with periosteal flap augmentation.

METHODS

Fourteen patients (mean age, 29.5 years; range, 18-45 years) who underwent revision MBP combined with periosteal flap augmentation between 2018 and 2023 were retrospectively reviewed. The mean follow-up duration was 23.7 months (18-32 months). Clinical outcomes were assessed using the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Karlsson-Peterson score. Radiographic evaluation included talar tilt angle and anterior talar displacement.

RESULTS

At a mean follow-up of 23.7 months (18-32 months), all clinical scores improved significantly (VAS: 5.9 to 1.6; AOFAS: 64.1 to 90.6; Karlsson-Peterson: 50.7 to 90.0; p < 0.001). Radiographic stability also improved significantly (talar tilt: 10.7° to 4.9°; anterior displacement: 8.9 mm to 4.1 mm; p < 0.001). No recurrent instability was observed. Three patients had minor wound complications, all of which resolved with conservative treatment.

CONCLUSIONS

Revision MBP with periosteal flap augmentation showed favorable short-term clinical and radiographic outcomes in patients with recurrent CAI after failed MBP. This technique may serve as a useful autologous reinforcement option in selected revision cases.