{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:26:42Z","timestamp":1792132002245,"version":"4.4.0"},"reference-count":32,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2012,9,7]],"date-time":"2012-09-07T00:00:00Z","timestamp":1346976000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2012,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Despite the popularity of the Brostr\u00f6m procedure for secondary repair of chronic lateral ankle instability, there have been no biomechanical studies reporting on the strength of this secondary repair method, whether using suture fixation or suture anchors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>The purpose of our study was to perform a biomechanical comparison of the ultimate load to failure and stiffness of the traditional Brostr\u00f6m technique using only a suture repair compared with a suture anchor repair of the anterior talofibular ligament (ATFL) at time zero. We believed that fixation strength of the suture anchor repair would be closer to the strength of the native ligament and allow more aggressive rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Twenty-four fresh-frozen cadaveric ankles were randomly divided into 4 groups of 6 specimens. One group was an intact control group, and the other groups consisted of the traditional Brostr\u00f6m and 2 suture anchor modifications (suture anchors in talus or fibula) of the Brostr\u00f6m procedure. The specimens were loaded to failure to determine the strength and stiffness of each construct.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In load-to-failure testing, ultimate failure loads of the Brostr\u00f6m (68.2 \u00b1 27.8 N;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .013), suture anchor fibula (79.2 \u00b1 34.3 N;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .037), and suture anchor talus (75.3 \u00b1 45.6 N;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .027) repairs were significantly lower than that of the intact (160.9 \u00b1 72.2 N) ATFL group. Stiffness of the Brostr\u00f6m (6.0 \u00b1 2.5 N\/mm;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02), suture anchor fibula (6.8 N\/mm \u00b1 2.7;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .05), and suture anchor talus (6.6 N\/mm \u00b1 4.0;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .04) repairs were significantly lower than that of the intact (12.4 N\/mm \u00b1 4.1 N\/mm) ATFL group. The 3 repair groups were not significantly different from each other, but all 3 were substantially lower in strength and stiffness when compared to the intact ATFL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The use of suture anchors to repair the ATFL produces a repair that can withstand loads to failure similar to the suture-only Brostr\u00f6m repair. However, all 3 repair groups were much weaker than the intact, uninjured ATFL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Biomechanically, the results show that both suture anchor and direct suture repair of the ATFL provide similar strength and stiffness. Unfortunately, these methods provide less than half the strength and stiffness of the native ATFL at time zero. As a result, regardless of the repair method, it is necessary to sufficiently protect the repair to avoid premature failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0363546512458420","type":"journal-article","created":{"date-parts":[[2012,9,8]],"date-time":"2012-09-08T01:47:00Z","timestamp":1347068820000},"page":"2590-2596","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":118,"title":["Anatomic Suture Anchor Versus the Brostr\u00f6m Technique for Anterior Talofibular Ligament Repair"],"prefix":"10.1177","volume":"40","author":[{"suffix":"III","given":"Norman E.","family":"Waldrop","sequence":"first","affiliation":[{"name":"Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado"},{"name":"The Steadman Clinic, Vail, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coen A.","family":"Wijdicks","sequence":"additional","affiliation":[{"name":"Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle S.","family":"Jansson","sequence":"additional","affiliation":[{"name":"Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"LaPrade","sequence":"additional","affiliation":[{"name":"The Steadman Clinic, Vail, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas O.","family":"Clanton","sequence":"additional","affiliation":[{"name":"The Steadman Clinic, Vail, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,9,7]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354658501300602"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000183737.43245.26"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659702500402"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-199723020-00001"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199901000-00024"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546505282616"},{"key":"e_1_3_3_8_2","first-page":"537","article-title":"Sprained ankles. V. Treatment and prognosis in recent ligament ruptures","volume":"132","author":"Brostr\u00f6m L","year":"1966","unstructured":"Brostr\u00f6m L. Sprained ankles. V. Treatment and prognosis in recent ligament ruptures. Acta Chir Scand. 1966;132:537-550.","journal-title":"Acta Chir Scand"},{"key":"e_1_3_3_9_2","first-page":"551","article-title":"Sprained ankles. VI. Surgical treatment of \u201cchronic\u201d ligament ruptures","volume":"132","author":"Brostr\u00f6m L","year":"1966","unstructured":"Brostr\u00f6m L. Sprained ankles. VI. Surgical treatment of \u201cchronic\u201d ligament ruptures. Acta Chir Scand.1966;132:551-565.","journal-title":"Acta Chir Scand"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659202000518"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/003591575304600507"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fcl.2006.07.002"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1249\/01.mss.0000222827.56982.40"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079801901002"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079902000407"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110078000100206"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079301400101"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.1100080409"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659602400402"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110079401500204"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198509000-00030"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198870040-00015"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659702500109"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2008.1126"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0838.2002.02104.x"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.73B1.1991787"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546508327541"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070002101203"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.80B1.8014"},{"key":"e_1_3_3_30_2","first-page":"235","article-title":"Early functional outcome of a modified Brostr\u00f6m-Gould surgery using bioabsorbable suture anchor for chronic lateral ankle instability","volume":"51","author":"Shahrulazua A","year":"2010","unstructured":"Shahrulazua A, Ariff Sukimin MS, Tengku Muzaffar TMS, Yusof MI. Early functional outcome of a modified Brostr\u00f6m-Gould surgery using bioabsorbable suture anchor for chronic lateral ankle instability. Singapore Med J. 2010:51:235-241.","journal-title":"Singapore Med J"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509350757"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.01537"},{"key":"e_1_3_3_33_2","first-page":"3","article-title":"Treatment of chronic, two-plane instability of the ankle joint: syndesmoplasty versus periosteal flap versus tenodesis","volume":"29","author":"Zwipp H","year":"1990","unstructured":"Zwipp H. Treatment of chronic, two-plane instability of the ankle joint: syndesmoplasty versus periosteal flap versus tenodesis. J Foot Surg. 1990;29:3-12.","journal-title":"J Foot Surg"}],"container-title":["The American Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0363546512458420","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0363546512458420","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0363546512458420","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:45:55Z","timestamp":1777369555000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0363546512458420"}},"subtitle":["A Biomechanical Comparison"],"short-title":[],"issued":{"date-parts":[[2012,9,7]]},"references-count":32,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2012,11]]}},"alternative-id":["10.1177\/0363546512458420"],"URL":"https:\/\/doi.org\/10.1177\/0363546512458420","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,9,7]]}}}