Brostrom with internal brace? This is a sprained ankle thing

Triathlon Forum
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short version. should i do one? have you done it? do you do this procedure to others? what do you think???

I posted 8 weeks ago about running on a sprained ankle, basically sprained bad for the third time in my life, all about 5 or 6 years apart. every time it takes a while to heal, basically until i buck up and wear a brace 24 7 for a while like, 6 plus weeks… I’ve been running on it and that is actually fine, i never have issues, my re injuries so far have all been, flip turns, stepping on toys, today i threw a tire threw a window before we tore a building down and yep again, nothing big, like i will run without hesitation. if your bored cookiebuilder is my insta and has the video of the tire throw and my right foot is the bad one…

Anyhoo I went to the doc because I’m a hypochondriac, a orthopedic foot guy specialist he could see in a xray the bone had been pulled off a few different times and then he tested my ankle he says i have really no more lateral stability, he recommends the brostum with a internal brace. It’s obviously not a must do, I am sure i could really baby this thing for a bit and get scar tissue to build up enough that a flip turn wouldn’t re injure it. But from what he says recovery is pretty quick and then I have a solid ankle again. he called it a home run surgery. So who has done it? and docs of the world should i do it??? what do you guys know?? btw I searched for this thread already and we need a good one for people to reference, not much on the twitch or lets run about this TIA!

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morning bump
.

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shameless final bump come on guys!

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shameless final bump come on guys!

As the leading orthopedic surgeon in the United States, I say go for it!

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Thanks for your help! do you live in Utah do you want to cut my leg open? also why the crap is noone commenting on this awesome thread that i even added a instagram video of a tire throw through a window? People stop reading the Ashley Horner thread!

https://www.instagram.com/p/BmgUvYkHHst/?taken-by=cookiebuilder

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haha! thanks my first real reply!

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I responded to your original plea for advice, with almost exactly what you posted here- history of bad sprains, ankle being held together by scar tissue and a prayer. I had the Brostrum procedure, was non-weight bearing for about 10 weeks, and that Fall I played in my final collegiate field hockey season like nothing had ever happened over the course of a decade of sprain and resprains.

It’s not a matter of “babying it for flip turns”. It’s a matter of gaining the stability you’ll need to do simple things like walk and stand up in a matter of years.

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thank you for reposting, at the time of my first post I had no idea what the brostrom was and i probably did not pay attention thank you!

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I do this procedure (Brostrom with internal brace (I assume here you are referring to the Arthrex fiber tape variety)).

Have been doing the Brostrom procedure for about 20 years and added the internal brace (I’ve been to Arthrex headquarters down in Naples and consult with them) has definitely been a game changer (both in recovery and stability). I’m not a fan of the peroneal tendon harvesting procedures (i.e. Cristman-Snook, etc.)

Having said that, this is a discussion you must have with your hands on guy/gal. From what you posted, it does not appear that the surgery is warranted since you can do what you want and only have a sprain “every 4+ years”? Probably half of this forum falls into that history. I’m usually doing this procedure (usually younger women) with 6 sprains per year or chronic pain that is inhibiting their activity (whatever that may be). I do like an MRI as well, though some just go by history and clinical exam.

Best of luck.

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Thanks, I was kind of thinking the same thing. I felt like I was an average ankle sprain guy and now I am supposed to go get surgery? I talked to the PT for the doctor, and they are saying even with the internal brace it is a longish recovery, so that is not super exciting either… back to feeling like i am running normal again in 3 months, maybe 10 weeks to start training ish. all of this seem not worth it. Thank you!

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Woah, awesome to read your thoughts!

I am just discovering this forum as I try to glean every bit on info about this procedure, it’s indications, and outcomes.

If anyone would like to comment on my case, it would be so much appreciated!

I am 47m, very active runner
I have had only a few sprains in my life, the last and worst was 5 years ago, stepping off a curb while running at night.
I recovered from that sprain and have been running for the past 5 years with zero issues.
About 1 year ago, I fell out of a kayak (ankles strapped in) with what seemed like a very minor sprain of the R ankle
Since then, vague feeling of wobbly in R ankle and pain in the anterolateral aspect after activity
Palpable pain localized to anterolateral ankle after activity, the more strenuous, the worse it is and longer it lasts.
No rolling of the ankle at all, it seems functionally stable from my POV except the vague wobbly feeling, which is unnerving.

MRI: OLD ATFL tear and fibular avulsion fracture with fragment measuring 1.4 x .6 cm. Some of the ATFL can be seen hanging onto the fragment, which might have a fibrous union with the distal fibula. It’s adjacent to the fibula with just a thin line between the two. The fragment is quite angular with a pointy corner seeming to bump into the talus in some images.

Exam: total laxity in BOTH ankles. Other ankle is completely asymptomatic.

My problem is any significant activity that I do without a brace results in several days of significant soreness. I can wear a splint and I am basically fine. I did about 1000 steps (up only - elevator down) in a splint and felt great. But I am wearing the splint to work because long walks from the parking lot and stairs cause flare ups.

I continue to remain active but no running, and all activities require a splint.

Ortho suggesting arthroscopy and Brostrom to remove fragment and reconstruct with Arthrex brace.

I’ve read many accounts of people who had Brostrom and continue to use ankle splint, continue to take ibuprofen and ice, etc. If that’s the case, it’s not worth doing for me.

Obviously there is a risk of complication, etc. But is it reasonable to expect improvement from this procedure? If I could get back to running and not require a splint for all activity, that would be incredible.

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Your case/symptoms are very different then Cookies and you would likely benefit from the procedure(s)

BTW, that is an odd MRI report. Very detailed, but strange verbage for a radiologist.

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Thank you, I think you’re right…

Some of the description is my own. I’m an MD but not radiologist. I reviewed with a radiologist. Report attached.

Should I be concerned about the new distance between the talus and fibula, after removing that massive avulsed fragment? Just worried about losing a lot of ROM and the general change in anatomy…

Thanks again!

mriankle.png

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Thank you, I think you’re right…

Some of the description is my own. I’m an MD but not radiologist. I reviewed with a radiologist. Report attached.

Should I be concerned about the new distance between the talus and fibula, after removing that massive avulsed fragment? Just worried about losing a lot of ROM and the general change in anatomy…

Thanks again!

Ah, that makes sense and sheds some light …

Hard to say (about the avulsion fragment). Those are pretty common. If large enough, they can be fixated but I’ll assume your surgeon has seen this and recommends removing it and repairing/recreating your ATF ligament with the Arthrex internal brace “backstop”. That is not usually an issue and any tightness that may ensue should be superior to your current instability.

The concern is that there are usually 3 anchors placed in the distal fibula (2 for the ATF repair and one for the brace) and if the avulsion fx is large enough, might be enough room or too tight after removing it. He/she is going to have to do this open rather than the “all internal” arthroscopic approach. FYI - All the cool kids are attempting the all internal way now, but I find it much harder to do well and leaves a lot of room for error.

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That’s really good info. I sure do appreciate you taking the time. Many thanks!