High Infection Rate in Open Anterior Talofibular Ligament Repair with Internal Brace Augmentation and Immediate Permissive Weight Bearing

Background Modified Broström repair is the gold standard for chronic lateral ankle instability. Internal brace augmentation was introduced to increase ligament strength and allow earlier rehabilitation, but concerns exist regarding surgical site infection (SSI).Purpose To compare the incidence of SSI following anterior talofibular ligament (ATFL) repair with internal brace augmentation and immediate permissive weight bearing versus ATFL repair without augmentation and restricted rehabilitation.Study design Retrospective cohort study.Methods Patients undergoing open ATFL repair with internal brace augmentation and immediate permissive weight bearing (ATFL-IB group) between January 2022 and February 2024 (n = 34) were compared with patients undergoing open ATFL repair without augmentation and restricted rehabilitation (ATFL group) between January 2016 and March 2019 (n = 31). The primary outcome was SSI, defined as infection within 90 days requiring antibiotic therapy or surgical intervention. Secondary outcomes included other complications. Baseline characteristics and SSI-related risk factors were assessed.Results SSI occurred in 5 patients (15%) in the ATFL-IB group and none in the ATFL group (0%) (p = .034). Other complications included persistent ankle instability (3%) and malposition (3%) in the ATFL-IB group and knot pain (3%) in the ATFL group. Baseline characteristics and operative time were comparable, only smoking prevalence was higher in the ATFL group.Conclusions ATFL repair with internal brace augmentation and immediate permissive weight bearing was associated with a higher SSI rate compared with ATFL repair without augmentation and restricted rehabilitation. Because augmentation and rehabilitation differed concurrently, their relative contributions could not be determined.