Patient-Reported Outcomes of Concomitant Deltoid and/or Syndesmotic Repair in Patients Undergoing Broström for Chronic Ankle Instability

Category: Ankle, Sports Keywords: Broström, Syndesmotic Injury, Deltoid Ligament Injury Introduction/Purpose: Prior literature suggests that concurrent medial and syndesmotic instability are risk factors for higher rates of postoperative dissatisfaction and failure to return to pre-injury activity. However, few studies have evaluated patient-reported outcomes following concurrent deltoid and/or syndesmotic repair in patients suffering from chronic ankle instability (CAI). While Rigby, et al. suggested that patients with associated deltoid repair had improved Patient Reported Outcomes Measurement Information System (PROMIS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores, average follow-up was less than one year. This investigation aims to understand the extent to which deltoid and/or syndesmotic repair bolster ankle stability in patients suffering from CAI as measured by the validated Cumberland Ankle Instability Tool (CAIT) and PROMIS in patients with minimum one year follow-up. Methods: All patients who underwent lateral ankle ligament reconstruction at a single institution (2013-2024) 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, those without minimum one year follow-up, and those who did not have preoperative CAIT (routinely collected at our institution) were excluded. 113 patients with deltoid and/or syndesmotic injury were identified. Deltoid injury was identified via MRI as edema at the medial malleolus and signal changes at the deltoid origin. Syndesmotic injury was determined via intraoperative fluoroscopic and direct visual examination. These 113 patients were contacted to complete postoperative surveys containing CAIT and PROMIS. 71/113 completed surveys and were included for final analysis. Primary outcome was change in CAIT compared to preoperative CAIT. Paired T- tests were used to compare CAIT preoperatively and postoperatively. Results: For concomitant deltoid repair (n=27), mean postoperative CAIT improved by 16.9 points (95%CI=13.8-20.0, P<.001). Mean scoring for PROMIS physical function (PF) was 52.8±6.5, PROMIS pain interference (PI) was 47.5±7.5, and postoperative CAIT was 22.1±7.2. Mean PF, PI and postoperative CAIT among those who underwent concomitant syndesmotic reconstruction (n=30) were 50.5±7.4, 49.9±7.9, and 18.9±8.7, respectively, mean postoperative CAIT improved by 12.5 (95%CI=8.3-16.8, P<.001) in this cohort. For patients who underwent both syndesmotic and deltoid repair (n=14), average CAIT improved by 17.7 (95%CI=13.7-21.8, P<.001). Mean PF, PI, and postoperative CAIT in this group were 51.9±6.3, 48.2±6.7, and 22.3±7.0, respectively. Conclusion: Concomitant deltoid and/or syndesmotic repair in patients undergoing Broström due to CAI results in significant improvements in ankle stability as measured by CAIT compared to patients’ preoperative baseline. These improvements exceed the minimal clinically important difference reported for CAIT. Addressing global stability should be prioritized in patients suffering from CAI, as patients who had deltoid and/or syndesmotic repair were able to achieve population mean functional outcomes as measured by PROMIS. This study is the first to evaluate CAIT in patients who underwent Broström associated with deltoid and/or syndesmotic repair.