Patient-Reported Outcomes of Concomitant Deltoid and/or Syndesmotic Reconstruction With Broström for Global Chronic Ankle Instability: The Role of Deltoid Stability

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Background: Medial and syndesmotic instability are risk factors for failure to return to pre-injury activity following Broström. This investigation aims to understand the extent to which superficial deltoid reconstruction (DR) and/or syndesmotic reconstruction (SR) affect global ankle stability in patients with global chronic ankle instability (GCAI) as measured by the validated Cumberland Ankle Instability Tool (CAIT) and Patient-Reported Outcomes Measurement Information System (PROMIS). Methods: All 574 patients who underwent lateral ankle ligament reconstruction at a single institution (2013-2024) were retrospectively reviewed. Revisions, allografts, nonanatomic reconstructions, flexor digitorum longus transfers, progressive collapsing foot deformity, hindfoot arthrodesis, ankle arthroplasties, fractures, those without minimum 1-year follow-up, and those who did not complete preoperative CAIT were excluded. Forty-three of 71 patients with concurrent deltoid and/or syndesmotic injury completed postoperative PROMIS/CAIT. GCAI was determined via history, examination, imaging, and intraoperative findings. Primary outcome was postoperative change in CAIT. Results: For patients who underwent concomitant DR (13/43), the mean CAIT score improved by 16.0 ± 8.9 points ( P < .001). The mean PROMIS physical function (PF) was 53.8 ± 6.8, the mean PROMIS pain interference (PI) was 46.7 ± 8.5, and the mean postoperative CAIT score was 22.0 ± 7.8. For those who had SR (16/43), the mean CAIT improved by 8.0 ± 12.6 ( P = .02). The mean PROMIS PF, PI, and postoperative CAIT scores among those who underwent associated SR were 49.3 ± 8.2, 51.3 ± 8.9, and 16.0 ± 9.1, respectively. For patients who underwent both SR and DR (14/43), average CAIT improved by 17.7 ± 7.0 ( P < .001). Mean PF, PI, and postoperative CAIT were 51.9 ± 6.3, 48.2 ± 6.7, and 22.3 ± 7.0, respectively. Change in CAIT was significantly higher in DR and DR+SR compared to SR alone ( P = .05). Conclusion: Concomitant DR/SR in patients undergoing Broström may be associated with significant improvements in ankle stability from preoperative baseline. Those with DR and DR+SR had the largest improvements in CAIT, which may suggest the role of deltoid stability in GCAI. Therefore, addressing global stability should be considered in some GCAI patients. Level of Evidence: Level III, retrospective comparative study.

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