Paper 61: Immediate weight bearing after modified-brostrom reconstruction: a retrospective review of an accelerated rehab protocol

Objectives: To determine whether suture-tape-augmented modified-Bröström reconstruction paired with a standardized immediate weight-bearing, accelerated rehabilitation protocol permits early functional recovery without increasing failure or complication rates. We hypothesized that this approach would enable patients to bear weight immediately after surgery and achieve high rates of return to activity while avoiding early reconstruction failure.
Methods: We retrospectively reviewed 133 patients treated by a single foot-and-ankle surgeon with suture-tape-augmented Bröström repair between August 2020 and January 2023. Inclusion required MRI-confirmed ATFL injury, failed non-operative management, and completion of six-week functional testing. Exclusions were concurrent procedures requiring grafts or osteotomies (CONSORT flow, Figure 1). All 119 included patients followed an accelerated protocol: weight bearing as tolerated (WBAT) in a CAM boot for two weeks, then WBAT in a lace-up brace for >=4 weeks with formal physiotherapy from week 2 (Table 1). Primary outcomes were single-leg heel-rise and hop tests at six weeks; secondary outcomes were VAS pain, complications, satisfaction, and 1-year return-to-sport.
Results: One hundred nineteen patients (85 female, 34 male; mean age 37 +- 12 years; mean BMI 30 +- 8 kg/m²) met all criteria and were followed for a mean of 16.7 +- 8.2 months. Concomitant cartilage injuries treated with marrow stimulation were present in 23 percent and did not affect outcomes. At 6 weeks, 90 percent of evaluated patients achieved a single-leg heel rise and 81 percent completed a single-leg hop; male sex predicted hop success (88 percent vs 77 percent, p = 0.04) (Table 2). Mean VAS at final follow-up was 1.0 +- 1.9. There were no reconstruction failures, revisions, infections, or deep venous thromboses. Transient neuritis occurred in 7 percent, and isolated calf tightness or swelling occurred in one patient each (Table 3). Among patients who participated in organized sports before surgery, 95 percent returned to sport within 12 months. Overall, 99 percent reported satisfaction with the procedure.
Conclusions: Suture-tape augmentation combined with immediate protected weight bearing achieved excellent early functional outcomes, minimal pain, high satisfaction, and a reliable return to sport without reconstruction failure. These findings support the safety and efficacy of an accelerated rehabilitation pathway after modified Broström repair and justify its use in both athletic and general populations.