Nonbiological Adjuncts for Ankle Stabilization

Chronic anterolateral ankle instability (CLAI) is a frequent pathology which might lead to incapacitating ankle dysfunction and/or pain either in athletes or general population. If neglected, CLAI can lead to late sequelae, such as impingement, cartilage damage, ankle arthritis, or deformities.

For patients who have failed conservative treatment, surgical management has been proposed with favorable outcome.

Nevertheless, several authors reported concerns with recurrent instability following acute reinjury and chronic damage of the repaired anterior talofibular ligament (ATFL).

Furthermore, the possibility of a more aggressive rehabilitation, enabling a faster return to activity, has also been pursuit.

These lead to the search of new “biomaterials” and possibly, advanced tissue engineering (in the future), in order to find possibilities to re-enforce ATFL repair, thus achieving “stronger” repairs, with lower failure risk and facilitating faster rehabilitation.

This chapter describes the possibility for high-molecular-weight polyethylene “suture-tape augmentation,” also known as “internal brace” (plus anchor/small inference screws), to augment ligament repair in modified Broström repair.

It has been reported that this augmentation enables greater resistance of the construct than the native ATFL (154 N). Still, it is not a biological approach at this time (acellular); thus, it has no positive effect in proprioception or vascularization. Biocompatibility of the material is of paramount importance.