Internal brace augmentation versus modified brostrom-gould procedure for chronic lateral ankle instability: a systematic review and meta-analysis of functional and radiographic outcomes

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• Picked for Anatomy (top studies of the week, 19 July 2026): High-quality evidence in a top journal
• Picked for Surgery (top studies of the week, 19 July 2026).

Abstract

PURPOSE: To compare functional, radiographic, and safety outcomes between internal brace (IB) augmentation and modified Broström-Gould (MBG) repair for chronic lateral ankle instability (CLAI), and to determine whether IB provides clinically relevant advantages over conventional anatomic repair. METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and prospectively registered in PROSPERO. PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus were searched from inception to January 2026. Randomized controlled trials and observational studies comparing IB augmentation with MBG repair for CLAI were included. The primary outcome was the Foot and Ankle Ability Measure (FAAM) Sports score. Secondary outcomes included Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) score, return-to-sport time and rate, complications, recurrence, talar tilt angle (TTA), anterior talar translation (ATT), and operative time. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analyses were performed. RESULTS: Thirteen comparative studies involving 1,015 patients (472 IB, 543 MBG) were included. IB was associated with a significant improvement in FAAM Sports score versus MBG (mean difference [MD] + 4.59; 95% confidence interval [CI] + 1.35 to + 7.82; I²=67.1%). After exclusion of a young female-specific cohort, the effect increased (MD + 6.06; 95% CI + 4.26 to + 7.86; I²=0%). Descriptively, IB patients returned to sport 4-8 weeks earlier than MBG patients across two studies; formal meta-analysis was not performed owing to the limited number of studies (k = 2). No significant between-group differences were observed for FAOS, AOFAS, return-to-sport rate, complications, recurrence, TTA, ATT, or operative time. CONCLUSION: IB augmentation was associated with better sports-specific function and earlier return to sport than MBG repair in patients with CLAI, without evidence of inferior radiographic or safety outcomes. These findings support IB as a useful surgical option, particularly for active patients in whom recovery trajectory and return to sport are important clinical priorities. REGISTRATION: This systematic review and meta-analysis was prospectively registered in PROSPERO (Registration No. CRD420261355719; registration date: 30 March 2026).

Abstract as published, via PubMed.