Which augmentation is more efficient for ankle lateral ligament repair: A biomecanical study

INTRODUCTION: Augmented repair is recommended in severe cases of ankle instability, but the technique remains debated. This study compared ankle and subtalar joint stability after Broström-Gould (BG) and Broström with inferior extensor retinaculum (IER) augmentation using a 3D opto-electronic protocol. METHODS: Eighteen cadaveric feet were tested in four conditions: intact, unstable (lateral ankle and subtalar ligaments disinserted), BG, and IER. Three manual tests were applied: anterior drawer (ADT), varus tilt in neutral (VTTN), and in dorsiflexion (VTTF). Ankle and subtalar rotations and ATFL/CFL elongation were recorded. RESULTS: Both techniques improved ankle and subtalar varus stability as well as ankle rotational stability (p < 0.05). Compared with BG, IER further reduced talus-calcaneus and tibia-calcaneus varus rotation during VTTN and VTTF (p < 0.05), and decreased tibia-talus flexion-extension during ADT (p < 0.05) CONCLUSION: IER provided greater ankle and subtalar varus stability than BG, though both limited motions compared with intact joints.