Repair of only anterior talofibular ligament resulted in similar outcomes to those of repair of both anterior talofibular and calcaneofibular ligaments

  • Kyung Rae Ko
  • Won-Young Lee
  • Hyobeom Lee
  • Hee Seol Park
  • Ki-Sun SungEmail author



To compare the surgical outcomes of the two different ankle stabilization techniques.


This randomized controlled trial aimed to compare the outcomes of the modified Broström procedure with [calcaneofibular ligament (CFL) group] or without CFL repair [anterior talofibular ligament (ATFL) only group]. Of the 50 patients randomly assigned to two groups, 43 were followed up prospectively for ≥ 2 years (CFL group: 22 patients, 36.6 ± 13.1 months; ATFL Only group: 21 patients, 35.3 ± 11.9 months). Functional outcomes were assessed using the Karlsson–Peterson and Tegner activity level scoring systems. Anterior talar translation (ATT), talar tilt angle (TTA), and degrees of displacement of the calcaneus against the talus on stress radiographs were measured. All parameters were compared between the two groups. Multiple regression analysis setting the postoperative Karlsson–Peterson score as the dependent variable was performed to determine the significant variable.


There were no significant differences between the two groups in functional (Karlsson–Peterson and Tegner activity level) scores at the last follow-up and their changes. There were no significant differences between the two groups in the ATT, TTA, their differences compared with the contralateral ankles, and degrees of displacement of the calcaneus against the talus at the last follow-up. Osteochondral lesion of the talus rather than CFL repair was the significant variable related to functional outcome.


The modified Broström procedure with additional CFL repair did not result in a significant advantage in any measured outcome at 3 years.

Level of evidence

Randomized controlled trial, Level I.


Chronic lateral ankle instability Modified Broström procedure Anterior talofibular ligament Calcaneofibular ligament Karlsson–Peterson score 



No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants.

Supplementary material

167_2018_5091_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 KB)


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

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