Stable ankle after modified brostrom technique using one anchor with double suture at Sanglah Hospital: a case report

I. Wayan Subawa, Dwiwahyonokusuma ., I. Gede Mahardika Putra


Ankle sprains are commonly seen injuries among athletic and young population, and it is necessary to stabilize the patient ankle as soon as possible. Authors report the cost-effective option of using a modified Brostrom technique with one suture anchor in a limited resource setting. Case a 24- year-old male came to the orthopaedic clinic with chief complaint of left ankle pain for the past 2 weeks after jumping and landing in a twisted position. Patient also complained of unstable ankle after the fall. On physical examination, the ankle showed tenderness and instability when anterior drawer test was performed. The patient was diagnosed with lateral ankle instability. This case report describes a modification to the original Brostrom procedure using one suture anchor to anatomically reconstruct the lateral ankle ligaments in treating high demand patient who have lateral ankle instability. After six months follow up, the patient has shown significant improvement on his left ankle. Despite of all the modifications of Brostrom procedure, the use of more suture anchors or sophisticated technique such as arthroscopy might result in increasing cost. Reasonably good outcome can still be achieved with modified Brostrom procedure that utilizes minimal incision, simple steps, and single suture anchor. Due to its cost-effectiveness, authors believe that modified Brostrom technique with one suture anchor is an effective and practical treatment option for lateral ankle instability. Brostrom technique using suture anchors as shown here can provide similarly good outcomes compared with other more complex techniques.


Ankle stability, Anterior talofibular ligament, Brostrom technique, Case report, Lateral ankle, One suture anchor

Full Text:



Bridgman SA, Clement D, Downing A, Walley G, Phair I, Maffulli N. Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains. Emerg Med J. 2003 Nov 1;20(6):508-10.

Colville MR. Surgical treatment of the unstable ankle. JAAOS-Journal of the Am Acad Orthopaed Surg. 1998 Nov 1;6(6):368-77.

Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont Jr PJ. The epidemiology of ankle sprains in the United States. JBJS. 2010 Oct 6;92(13):2279-84.

Hølmer P, Søndergaard L, Konradsen L, Nielsen PT, Jørgensen LN. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Inter. 1994 Feb;15(2):72-4.

Cameron KL, Owens BD, DeBerardino TM. Incidence of ankle sprains among active-duty members of the United States Armed Services from 1998 through 2006. J Athle Training. 2010 Jan;45(1):29-38.

Kris K, Marta A, Kawiyana IKS, Kris K, Marta A. Management of Acute Ankle Sprain : A Literature Review Faculty of Medicine. Indon J Biomed Sci. 2016;10(2):20-6.

Waldrop III 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 Spor Med. 2012 Nov;40(11):2590-6.

Juan AC, Alberto MV, Marcela P. Chronic Ankle Instability: Results with Brostrom-Evans Procedure. J Nov Physiother S. 2013;3:2.

Yoo JS, Yang EA. Clinical results of an arthroscopic modified Brostrom operation with and without an internal brace. J Orthopaed Traumatol. 2016 Dec 1;17(4):353-60.

Keller M, Grossman J, Caron M, Mendicino RW. Lateral ankle instability and the Brostrom-Gould procedure. J Foot Ankle Surg. 1996 Nov 1;35(6):513-20.