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Brostrom
- Delayed primary repair of the ligaments
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Essentially tighten up the existing scar tissue and ligaments
- Very successful and easy procedure
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Lateral Ankle Stabilizations
- harvest a tendon
graft
- utilize the graft to act as a ligament replacement
- utilized for heavier individuals
- utilized for ligamentously
lax individuals
- Very difficult procedure to perform especially for novice surgeons
- Effectiveness is only as
good as the surgeon
Most Common Procedures
- Chrisman-Snook
- Evans
- Jones
- Elmslie
- and the list
goes on and on and on
Thermal Shrinkage
- utilizes a thermal probe to heat up the capsule from the inside the joint
causing the capsular tissue to shrink
- technique is limited to mild instability cases only
- significant debate on
long-term effectiveness
Thermal Probes
- Oratec (good)
- Mitek Vapor (preferred)
- Arthrocare will have one
soon
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Tendon Graft possibilities
- Autograft (tendon
taken from your own body)
- Allograft (tendon taken from another person)
- Synthetic (man-made mesh)
Autograft
locations
Peroneus brevis/longus
- traditional choice
- not recommended anymore
- peroneal
tendons are the primary muscle stabilizers
Flexor tendons
- difficult to harvest
- very thin grafts
Plantaris
- easy to harvest
- very thin
- < 20% of the population do not have them
Semi-tendinosis
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easy to harvest
- very common graft site for knee operations
- length is never an issue
Allograft
-
excellent graft choices
- avoids additional surgeries
- safety has not been issue
Synthetic
- Use of Mylar
mesh and carbon fiber grafts have been used
- Allografts are used more often
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Classic Brostrom incision
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Our preferred incision for brostrom
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Brostrom procedure
- Utilizes the patient's own
scar tissue and joint capsule
- Redundant tissue can be removed or overlapped
- Tissue is sewed together using a combination
of sutures
- Often tissue maybe anchored back to the fibula
Anchoring techniques
- Drill holes
- Curvtek drill
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Anchors (metal or absorbable)
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Typical brostrom showing the position of the sutures
prior to tightening the repair
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Curvtek drill
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Curvtek drill hole placement on fibula
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