Research progress of Internal Brace suture tape augmentation technique in treatment of chronic lateral ankle instability_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Debiao ¹ , YE Huabin ² ,  LI Canfeng ^2,3

1. The First Clinical Medical College, Guangdong Medical University, Zhanjiang Guangdong, 524023, P. R. China;
2. Peking University-Shenzhen Clinical Institute of Shantou University Medical College, Shantou Guangdong, 515000, P. R. China;
3. Department of Sports Medicine, Peking University Shenzhen Hospital, Shenzhen Guangdong, 518000, P. R. China;

Corresponding?author：

LI Canfeng, Email: licanfeng87@163.com

Keywords：

Internal Brace; sutrue tape; augmentation technique; chronic lateral ankle instability

DOI：

10.7507/1002-1892.202602026

Video：

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Objective To systematically review the research progress of Internal Brace suture tape augmentation technique in the treatment of chronic lateral ankle instability (CLAI), and to provide reference for clinical practice. Methods The related literatures of Internal Brace suture tape augmentation technique in the treatment of CLAI were extensively reviewed at home and abroad, and the effectiveness was evaluated. Results Biomechanical studies showed that the Internal Brace suture tape augmentation technique significantly improved the immediate stability of ankle ligaments after repair. Clinical studies have shown that this technique alone or in combination with Brostr?m procedures can achieve good results in the treatment of CLAI, especially in patients with poor ligament stump quality, systemic ligament laxity, revision surgery, and high exercise needs. Conclusion Internal Brace suture tape augmentation technique is helpful for patients with CLAI to obtain immediate stability, accelerate rehabilitation, and early return to exercise, especially for patients with poor prognostic factors. More high-quality clinical studies are needed for further verification in the future.

Citation： CHEN Debiao, YE Huabin, LI Canfeng. Research progress of Internal Brace suture tape augmentation technique in treatment of chronic lateral ankle instability. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(7): 1136-1141. doi: 10.7507/1002-1892.202602026 Copy

1.	Donovan L, Linens SW, Hubbard-Turner T, et al. Participant demographics and research questions from 10-years of chronic ankle instability studies: A scoping review. J Sci Med Sport, 2025, 28(8): 636-644.
2.	Roos KG, Kerr ZY, Mauntel TC, et al. The epidemiology of lateral ligament complex ankle sprains in national collegiate athletic association sports. Am J Sports Med, 2017, 45(1): 201-209.
3.	Hintermann B, Boss A, Sch?fer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med, 2002, 30(3): 402-409.
4.	Dhillon MS, Patel S, Baburaj V. Ankle sprain and chronic lateral ankle instability: Optimizing conservative treatment. Foot Ankle Clin, 2023, 28(2): 297-307.
5.	Chiou D, Morris B, Waryasz G. Br?strom repair review. Foot Ankle Spec, 2024, 17(3): 277-283.
6.	Xiong S, Pan J, Xu X, et al. Clinical outcomes and sports participation after the modified brostr?m procedure in children and adolescents with chronic lateral ankle instability: A 5- to 10-year follow-up of 111 cases. Am J Sports Med, 2025, 53(10): 2454-2461.
7.	Liu ZF, Su T, Wang ZY, et al. Both arthroscopic one-step Brostr?m-Gould and Lasso-loop stitch techniques achieved favourable clinical outcomes for chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc, 2024, 32(6): 1622-1630.
8.	Waldrop NE, Wijdicks CA, Jansson KS, et al. Anatomic suture anchor versus the Brostr?m technique for anterior talofibular ligament repair: a biomechanical comparison. Am J Sports Med, 2012, 40(11): 2590-2596.
9.	Al-Obaidi I, Kendal A, Ramasamy A. Advances in foot and ankle surgery: a review of recent innovations. Bone Joint J, 2025, 107-B(3): 283-290.
10.	Maffulli N, Del Buono A, Maffulli GD, et al. Isolated anterior talofibular ligament Brostr?m repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med, 2013, 41(4): 858-864.
11.	Eble SK, Hansen OB, Patel KA, et al. Lateral ligament reconstruction with hamstring graft for ankle instability: Outcomes for primary and revision cases. Am J Sports Med, 2021, 49(10): 2697-2706.
12.	Lan R, Piatt ET, Bolia IK, et al. Suture tape augmentation in lateral ankle ligament surgery: Current concepts review. Foot Ankle Orthop, 2021, 6(4): 24730114211045978. doi: 10.1177/24730114211045978.
13.	Mackay GM, Blyth MJ, Anthony I, et al. A review of ligament augmentation with the InternalBrace?: the surgical principle is described for the lateral ankle ligament and ACL repair in particular, and a comprehensive review of other surgical applications and techniques is presented. Surg Technol Int, 2015, 26: 239-255.
14.	Huang Q, Ji XX, Zhu WH, et al. A new method of anterior talofibular ligament reconstruction: Arthroscopically artificial ligament reconstruction with tensional remnant-repair. Chin J Traumatol, 2023, 26(6): 317-322.
15.	Park KH, Lee JW, Suh JW, et al. Generalized ligamentous laxity is an independent predictor of poor outcomes after the modified Brostr?m procedure for chronic lateral ankle instability. Am J Sports Med, 2016, 44(11): 2975-2983.
16.	Cho BK, Kim YM, Choi SM, et al. Revision anatomical reconstruction of the lateral ligaments of the ankle augmented with suture tape for patients with a failed Brostr?m procedure. Bone Joint J, 2017, 99-B(9): 1183-1189.
17.	Garrick JG. The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med, 1977, 5(6): 241-242.
18.	Waterman BR, Owens BD, Davey S, et al. The epidemiology of ankle sprains in the United States. J Bone Joint Surg (Am), 2010, 92(13): 2279-2284.
19.	Michels F, Wastyn H, Pottel H, et al. The presence of persistent symptoms 12 months following a first lateral ankle sprain: A systematic review and meta-analysis. Foot Ankle Surg, 2022, 28(7): 817-826.
20.	Wang DY, Jiao C, Ao YF, et al. Risk factors for osteochondral lesions and osteophytes in chronic lateral ankle instability: A case series of 1169 patients. Orthop J Sports Med, 2020, 8(5): 2325967120922821. doi: 10.1177/2325967120922821.
21.	Yeung MS, Chan KM, So CH, et al. An epidemiological survey on ankle sprain. Br J Sports Med, 1994, 28(2): 112-116.
22.	Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train, 2002, 37(4): 364-375.
23.	Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train, 2019, 54(6): 572-588.
24.	Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med, 2014, 48(13): 1014-1018.
25.	Perez AR, Coladonato C, Muchintala R, et al. A systematic review of the biomechanical properties of suture materials used in orthopaedics. J Orthop, 2024, 51: 122-129.
26.	Kubo T, Takahashi T, Saitsu A, et al. Material properties of suture augmentation of knee medial collateral ligament repair did not influence length changes or failure loads in a caged porcine model. Arthrosc Sports Med Rehabil, 2023, 5(3): e629-e635.
27.	Kubo T, Takahashi T, Kimura M, et al. Biomechanical comparisons of anterior cruciate ligament avulsion fracture fixation using high-strength suture and ultra-high molecular weight polyethylene suture tape in a porcine model. J Knee Surg, 2022, 35(11): 1199-1203.
28.	Viens NA, Wijdicks CA, Campbell KJ, et al. Anterior talofibular ligament ruptures, part 1: biomechanical comparison of augmented Brostr?m repair techniques with the intact anterior talofibular ligament. Am J Sports Med, 2014, 42(2): 405-411.
29.	Lohrer H, Bonsignore G, Dorn-Lange N, et al. Stabilizing lateral ankle instability by suture tape—a cadaver study. J Orthop Surg Res, 2019, 14(1): 175. doi: 10.1186/s13018-019-1218-6.
30.	Willegger M, Benca E, Hirtler L, et al. Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1015-1021.
31.	Schuh R, Benca E, Willegger M, et al. Comparison of Brostr?m technique, suture anchor repair, and tape augmentation for reconstruction of the anterior talofibular ligament. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1101-1107.
32.	Vuurberg G, Altink N, Rajai M, et al. Weight, BMI and stability are risk factors associated with lateral ankle sprains and chronic ankle instability: a meta-analysis. J ISAKOS, 2019, 4(6): 313-327.
33.	Hoveidaei AH, Moradi AR, Nakhostin-Ansari A, et al. Risk factors of ankle sprain in soccer players: A systematic review and meta-analysis. Sports (Basel), 2025, 13(4): 105. doi: 10.3390/sports13040105.
34.	Guillo S, Bauer T, Lee JW, et al. Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. Orthop Traumatol Surg Res, 2013, 99(8 Suppl): S411-9. doi: 10.1016/j.otsr.2013.10.009.
35.	Li Y, Su T, Hu Y, et al. Return to sport after anatomic lateral ankle stabilization surgery for chronic ankle instability: A systematic review and meta-analysis. Am J Sports Med, 2024, 52(2): 555-566.
36.	Xu HX, Lee KB. Modified Brostr?m procedure for chronic lateral ankle instability in patients with generalized joint laxity. Am J Sports Med, 2016, 44(12): 3152-3157.
37.	Cho BK, Park KJ, Park JK, et al. Outcomes of the modified Brostr?m procedure augmented with suture-tape for ankle instability in patients with generalized ligamentous laxity. Foot Ankle Int, 2017, 38(4): 405-411.
38.	Kuhn MA, Lippert FG. Revision lateral ankle reconstruction. Foot Ankle Int, 2006, 27(2): 77-81.
39.	Comfort SM, Marchetti DC, Duncan PP, et al. Brostr?m repair with and without augmentation: Comparison of outcomes at median follow-up of 5 years. Foot Ankle Int, 2023, 44(8): 691-701.
40.	Martin KD, Andres NN, Robinson WH. Suture tape augmented Brostr?m procedure and early accelerated rehabilitation. Foot Ankle Int, 2021, 42(2): 145-150.
41.	Kulwin R, Watson TS, Rigby R, et al. Traditional modified Brostr?m vs suture tape ligament augmentation. Foot Ankle Int, 2021, 42(5): 554-561.
42.	Wenzel-Schwarz F, Wittig U, Nemecek E, et al. Brostr?m ankle ligament repair augmented with suture tape: Results of magnetic resonance imaging evaluation. Wien Klin Wochenschr, 2024, 136(19-20): 562-569.
43.	Dong Y, Jiang G, Liu M, et al. A randomized comparison between anterior talofibular ligament repair using Brostr?m operation with and without an internal brace. J Foot Ankle Surg, 2024, 63(4): 485-489.
44.	Ulku TK, Kocaoglu B, Tok O, et al. Arthroscopic suture-tape internal bracing is safe as arthroscopic modified Brostr?m repair in the treatment of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc, 2020, 28(1): 227-232.
45.	McMillan P, Wilson WT, Hopper GP, et al. Satisfactory patient reported outcomes at five years following primary repair with suture tape augmentation for anterior talofibular ligament injury. J Foot Ankle Surg, 2025, 64(5): 534-540.
46.	Cho BK, Kim SH. The modified Brostr?m procedure with suture-tape augmentation for chronic lateral ankle instability. J Clin Med, 2025, 14(5): 1683. doi: 10.3390/jcm14051683.
47.	Mercer NP, Kanakamedala AC, Azam MT, et al. Clinical outcomes after suture tape augmentation for ankle instability: A systematic review. Orthop J Sports Med, 2022, 10(5): 23259671221095791. doi: 10.1177/23259671221095791.

1. Donovan L, Linens SW, Hubbard-Turner T, et al. Participant demographics and research questions from 10-years of chronic ankle instability studies: A scoping review. J Sci Med Sport, 2025, 28(8): 636-644.
2. Roos KG, Kerr ZY, Mauntel TC, et al. The epidemiology of lateral ligament complex ankle sprains in national collegiate athletic association sports. Am J Sports Med, 2017, 45(1): 201-209.
3. Hintermann B, Boss A, Sch?fer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med, 2002, 30(3): 402-409.
4. Dhillon MS, Patel S, Baburaj V. Ankle sprain and chronic lateral ankle instability: Optimizing conservative treatment. Foot Ankle Clin, 2023, 28(2): 297-307.
5. Chiou D, Morris B, Waryasz G. Br?strom repair review. Foot Ankle Spec, 2024, 17(3): 277-283.
6. Xiong S, Pan J, Xu X, et al. Clinical outcomes and sports participation after the modified brostr?m procedure in children and adolescents with chronic lateral ankle instability: A 5- to 10-year follow-up of 111 cases. Am J Sports Med, 2025, 53(10): 2454-2461.
7. Liu ZF, Su T, Wang ZY, et al. Both arthroscopic one-step Brostr?m-Gould and Lasso-loop stitch techniques achieved favourable clinical outcomes for chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc, 2024, 32(6): 1622-1630.
8. Waldrop NE, Wijdicks CA, Jansson KS, et al. Anatomic suture anchor versus the Brostr?m technique for anterior talofibular ligament repair: a biomechanical comparison. Am J Sports Med, 2012, 40(11): 2590-2596.
9. Al-Obaidi I, Kendal A, Ramasamy A. Advances in foot and ankle surgery: a review of recent innovations. Bone Joint J, 2025, 107-B(3): 283-290.
10. Maffulli N, Del Buono A, Maffulli GD, et al. Isolated anterior talofibular ligament Brostr?m repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med, 2013, 41(4): 858-864.
11. Eble SK, Hansen OB, Patel KA, et al. Lateral ligament reconstruction with hamstring graft for ankle instability: Outcomes for primary and revision cases. Am J Sports Med, 2021, 49(10): 2697-2706.
12. Lan R, Piatt ET, Bolia IK, et al. Suture tape augmentation in lateral ankle ligament surgery: Current concepts review. Foot Ankle Orthop, 2021, 6(4): 24730114211045978. doi: 10.1177/24730114211045978.
13. Mackay GM, Blyth MJ, Anthony I, et al. A review of ligament augmentation with the InternalBrace?: the surgical principle is described for the lateral ankle ligament and ACL repair in particular, and a comprehensive review of other surgical applications and techniques is presented. Surg Technol Int, 2015, 26: 239-255.
14. Huang Q, Ji XX, Zhu WH, et al. A new method of anterior talofibular ligament reconstruction: Arthroscopically artificial ligament reconstruction with tensional remnant-repair. Chin J Traumatol, 2023, 26(6): 317-322.
15. Park KH, Lee JW, Suh JW, et al. Generalized ligamentous laxity is an independent predictor of poor outcomes after the modified Brostr?m procedure for chronic lateral ankle instability. Am J Sports Med, 2016, 44(11): 2975-2983.
16. Cho BK, Kim YM, Choi SM, et al. Revision anatomical reconstruction of the lateral ligaments of the ankle augmented with suture tape for patients with a failed Brostr?m procedure. Bone Joint J, 2017, 99-B(9): 1183-1189.
17. Garrick JG. The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med, 1977, 5(6): 241-242.
18. Waterman BR, Owens BD, Davey S, et al. The epidemiology of ankle sprains in the United States. J Bone Joint Surg (Am), 2010, 92(13): 2279-2284.
19. Michels F, Wastyn H, Pottel H, et al. The presence of persistent symptoms 12 months following a first lateral ankle sprain: A systematic review and meta-analysis. Foot Ankle Surg, 2022, 28(7): 817-826.
20. Wang DY, Jiao C, Ao YF, et al. Risk factors for osteochondral lesions and osteophytes in chronic lateral ankle instability: A case series of 1169 patients. Orthop J Sports Med, 2020, 8(5): 2325967120922821. doi: 10.1177/2325967120922821.
21. Yeung MS, Chan KM, So CH, et al. An epidemiological survey on ankle sprain. Br J Sports Med, 1994, 28(2): 112-116.
22. Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train, 2002, 37(4): 364-375.
23. Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train, 2019, 54(6): 572-588.
24. Gribble PA, Delahunt E, Bleakley C, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med, 2014, 48(13): 1014-1018.
25. Perez AR, Coladonato C, Muchintala R, et al. A systematic review of the biomechanical properties of suture materials used in orthopaedics. J Orthop, 2024, 51: 122-129.
26. Kubo T, Takahashi T, Saitsu A, et al. Material properties of suture augmentation of knee medial collateral ligament repair did not influence length changes or failure loads in a caged porcine model. Arthrosc Sports Med Rehabil, 2023, 5(3): e629-e635.
27. Kubo T, Takahashi T, Kimura M, et al. Biomechanical comparisons of anterior cruciate ligament avulsion fracture fixation using high-strength suture and ultra-high molecular weight polyethylene suture tape in a porcine model. J Knee Surg, 2022, 35(11): 1199-1203.
28. Viens NA, Wijdicks CA, Campbell KJ, et al. Anterior talofibular ligament ruptures, part 1: biomechanical comparison of augmented Brostr?m repair techniques with the intact anterior talofibular ligament. Am J Sports Med, 2014, 42(2): 405-411.
29. Lohrer H, Bonsignore G, Dorn-Lange N, et al. Stabilizing lateral ankle instability by suture tape—a cadaver study. J Orthop Surg Res, 2019, 14(1): 175. doi: 10.1186/s13018-019-1218-6.
30. Willegger M, Benca E, Hirtler L, et al. Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1015-1021.
31. Schuh R, Benca E, Willegger M, et al. Comparison of Brostr?m technique, suture anchor repair, and tape augmentation for reconstruction of the anterior talofibular ligament. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1101-1107.
32. Vuurberg G, Altink N, Rajai M, et al. Weight, BMI and stability are risk factors associated with lateral ankle sprains and chronic ankle instability: a meta-analysis. J ISAKOS, 2019, 4(6): 313-327.
33. Hoveidaei AH, Moradi AR, Nakhostin-Ansari A, et al. Risk factors of ankle sprain in soccer players: A systematic review and meta-analysis. Sports (Basel), 2025, 13(4): 105. doi: 10.3390/sports13040105.
34. Guillo S, Bauer T, Lee JW, et al. Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. Orthop Traumatol Surg Res, 2013, 99(8 Suppl): S411-9. doi: 10.1016/j.otsr.2013.10.009.
35. Li Y, Su T, Hu Y, et al. Return to sport after anatomic lateral ankle stabilization surgery for chronic ankle instability: A systematic review and meta-analysis. Am J Sports Med, 2024, 52(2): 555-566.
36. Xu HX, Lee KB. Modified Brostr?m procedure for chronic lateral ankle instability in patients with generalized joint laxity. Am J Sports Med, 2016, 44(12): 3152-3157.
37. Cho BK, Park KJ, Park JK, et al. Outcomes of the modified Brostr?m procedure augmented with suture-tape for ankle instability in patients with generalized ligamentous laxity. Foot Ankle Int, 2017, 38(4): 405-411.
38. Kuhn MA, Lippert FG. Revision lateral ankle reconstruction. Foot Ankle Int, 2006, 27(2): 77-81.
39. Comfort SM, Marchetti DC, Duncan PP, et al. Brostr?m repair with and without augmentation: Comparison of outcomes at median follow-up of 5 years. Foot Ankle Int, 2023, 44(8): 691-701.
40. Martin KD, Andres NN, Robinson WH. Suture tape augmented Brostr?m procedure and early accelerated rehabilitation. Foot Ankle Int, 2021, 42(2): 145-150.
41. Kulwin R, Watson TS, Rigby R, et al. Traditional modified Brostr?m vs suture tape ligament augmentation. Foot Ankle Int, 2021, 42(5): 554-561.
42. Wenzel-Schwarz F, Wittig U, Nemecek E, et al. Brostr?m ankle ligament repair augmented with suture tape: Results of magnetic resonance imaging evaluation. Wien Klin Wochenschr, 2024, 136(19-20): 562-569.
43. Dong Y, Jiang G, Liu M, et al. A randomized comparison between anterior talofibular ligament repair using Brostr?m operation with and without an internal brace. J Foot Ankle Surg, 2024, 63(4): 485-489.
44. Ulku TK, Kocaoglu B, Tok O, et al. Arthroscopic suture-tape internal bracing is safe as arthroscopic modified Brostr?m repair in the treatment of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc, 2020, 28(1): 227-232.
45. McMillan P, Wilson WT, Hopper GP, et al. Satisfactory patient reported outcomes at five years following primary repair with suture tape augmentation for anterior talofibular ligament injury. J Foot Ankle Surg, 2025, 64(5): 534-540.
46. Cho BK, Kim SH. The modified Brostr?m procedure with suture-tape augmentation for chronic lateral ankle instability. J Clin Med, 2025, 14(5): 1683. doi: 10.3390/jcm14051683.
47. Mercer NP, Kanakamedala AC, Azam MT, et al. Clinical outcomes after suture tape augmentation for ankle instability: A systematic review. Orthop J Sports Med, 2022, 10(5): 23259671221095791. doi: 10.1177/23259671221095791.

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