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Running On: InternalBrace™ Ligament Augmentation Repair Gets Ultrarunner Back on the Trail



Bethany Murray loves a challenge.

While preparing to run a marathon in St. Louis, she trained with friends, one of whom was an ultrarunner.

“I thought, if she can do it, I can do it,” she said. “And so I ran that race, then a 50-miler and so on. It’s a progressive disease, ultrarunning. You just want to push the envelope more and more.”

The runs took her from St. Louis to her current home in Steamboat Springs, Colorado, where she discovered a love of running on trails.

She was at her peak fitness level, she said, when she went out for the routine 10-mile run that would change everything.

Bethany“I wasn’t doing anything technical; it was just a normal, leisurely run. All of a sudden, my right foot folded under me,” she said. “I heard a pop and suddenly I couldn’t put any weight on it. Although I had my phone, it didn’t have a signal and I was chasing daylight. I needed to make it out of the mountains, so on I trudged. I knew my race season was over and, being the stubborn person I am, I foolishly kept running on it.”

Dr. Joshua Metzl, the Denver-based orthopedic surgeon who treated Bethany, diagnosed her with a severe ankle sprain, initially treating her conservatively with physical therapy, bracing and asking Bethany to decrease her weekly mileage until the pain subsided.

Bethany said the initial injury took 10 months of recovery – pure torture to the ultrarunner, triathlete and mountain biker who loves to be outside.

“I couldn’t do anything. I couldn’t even swim. My foot was a floppy noodle,” she said.

BethanyThat initial injury eventually healed, but it didn’t stay that way, Bethany said.

“I kept reinjuring it randomly. I couldn’t trust it. It was demoralizing,” she said. “I wasn’t enjoying what I was doing. And I would replay the injury in my head.”

Bethany said she would do some sort of physical activity and wonder if this would be the time she injured her ankle again.

After about three years of various treatments and eventually feeling that she didn’t have stability on her ankle 

anymore, Bethany needed another option.

MetzlDr. Metzl, who also serves as head orthopedic physician for the Colorado Ballet as well as assistant team physician for the Denver Broncos and Colorado Rockies, told her surgery was the answer.

“Her pain was severe enough and her ability to do the things she loved just never returned,” he said. “Her whole life has been outdoors and I wanted her to be able to get back out to doing what she loved.”

Dr. Metzl spoke to Bethany about Arthrex’s InternalBrace ligament augmentation system, which can be used to repair acute and chronic ankle sprains. The InternalBrace system supplements an existing procedure by not allowing the ankle to bend beyond a certain point.

“The InternalBrace system augments the ligament repair or reconstruction. It’s very helpful in very active people because with the added stability, you can mobilize it earlier, you have enhanced confidence and you are not going to spend six weeks in a cast,” Dr. Metzl said. “It allows you to accelerate your rehabilitation so you are back to doing what you love.”

BethanyResearch has also shown that InternalBrace augmentation of a Broström repair (fixing the ligaments on the outer side of the ankle) produces favorable patient outcomes in terms of preventing recurrent ankle sprains in the short term.

Bethany said it was the option she needed.

“I wanted surgery, recovery and to be done,” she said. “The subsequent injuries had just degraded my ankle.”

Two weeks after having her surgery in June 2017, Bethany climbed the Manitou Incline, a 2,744-step trail that gains 2,000 feet in elevation from start to finish, on crutches.

“I didn’t miss out on too much,” she said with a laugh. “I had a plan to stay active, but I didn’t set a goal of registering for a race or putting pressure on myself to be ready to do something at a certain time after my surgery. I just wanted to get stronger, build my base so that I have a strong foundation.”

Bethany was able to do many things even while still in the boot, including hiking, paddleboarding and fishing, although she points out that she consulted with Dr. Metzl before trying some activities.

“My attitude was that I would tow the line, but never cross it and possibly reinjure my ankle again. But I would do everything up to that line. So, if I wanted to do an Alpine Lake hike, I would call Dr. Metzl and say, ‘Let’s say I wanted to do this, what would you recommend I do?’ And he would say, ‘I know you are going to do it anyway, so make sure you have trekking poles or a stabilizer like your crutches to help you,’” she said.

While Bethany isn’t the typical patient with a typical recovery after a procedure such as this, Dr. Metzl said he wasn’t concerned about how physical Bethany was after surgery because he “knew how solid the repair was.”

“That’s the advantage with InternalBrace. The enhanced stability of the repair allowed me to return her to sports quickly without concern that the repair would elongate. It is a great solution for athletes, whether you are a serious athlete like Bethany, a recreational athlete, a professional athlete. It offers a significant advantage over traditional ligament repair,” he said.

BethanyBethany, 33, was hiking and was back to running two months after her surgery.

“I had a good recovery,” she said. “It was tailored to me and my lifestyle and that was important to me.”

She is now training for the Tahoe Rim Trail 100 mile endurance run in July, about one year after surgery.

“I feel great. I feel stronger,” she said. “It’s like I have hit the reset button.”

Disclaimer: The views expressed in this article reflect the experience and opinions of those involved and do not necessarily reflect those of Arthrex, Inc. This is not medical advice from Arthrex. Postoperative management is patient specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level and/or outcomes. Patient images, videos and/or testimonials are used with express written authorization of the patient or their legal guardian.

Category: Arthrex News