In 1966, Brostrom14 first reported on 60 patients who underwent delayed direct repair of the ATFL and CFL by shortening of the torn ends and midsubstance suturing (Fig. 66-2). Gould et al35 modified this procedure in 1980 by adding an advancement of the extensor retinaculum over the Brostrom repair. The Gould modification reinforces the repair, limits inversion, and helps to correct the subtalar component of instability.
Two surgical approaches are commonly used for this procedure: (1) an anterior incision along the distal and anterior border of the fibula (if no extra-articular pathology is suspected) or (2) a curvilinear posterior incision along the posterior border of the fibula (if peroneal tendon or retinacular pathology is suspected). An anterolateral arthrotomy is performed with caution to identify and protect branches of the sural and superficial peroneal nerves. The ATFL and CFL are divided in midsubstance and shortened/imbricated in standard vest-over-pants technique with 2-0 nonabsorbable braided suture. With the ankle in slight plantarflexion and eversion, the CFL sutures are secured first. The posterior heel is suspended and the ATFL sutures are then tied with caution to avoid anterior subluxation of the talus. Last, the repair is reinforced with the Gould modification as the extensor retinaculum is advanced and secured to the distal fibula.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.