Name: Augmented Brostrom Post-Op Protocol
Uploaded: 2017-03-30T00:00:00Z
Channel: Arthrex
Description: J. Chris Coetzee, MD, MB, ChB, (Minneapolis, MN) discusses his postoperative rehabilitation of lateral ankle instability repair with Brostrom and Internal Brace™ ligament augmentation.

<p>J. Chris Coetzee, MD, MB, ChB, (Minneapolis, MN) discusses his postoperative rehabilitation of lateral ankle instability repair with Brostrom and<em> Internal</em>Brace™ ligament augmentation.</p>

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VID1-00999-EN | B | Augmented Brostrom Post-Op Protocol

J. Chris Coetzee

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Augmented Brostrom Post-Op Protocol

I want to talk about my rare protocol for InternalBrace AugMend ArthroBrostrom. As you know, this is a fairly significant change from what we usually do for rehabilitation because with a conventional system, you have to be very careful not to overstretch too soon. And thinking about the biology, it probably takes six months to fully recover and mature, while with the InternalBrace you can skip most of that because the brace protects your repair while it matures. So with a conventional ArthroBrostrom, usually two weeks in a cast and four weeks in a boot, they have to be none or minimal weight bearing not to overstretch your repair and rehab starts at six weeks, and usually it takes six months to return to play, and it depends upon the maturity of the tissue at that time. And I always say you cannot cheat biology, so no matter how you fix your ligament, it still takes six months to mature. While with the internal brace, we can speed that up significantly. I put them in a cast for two weeks and that's really just to slow them down. I don't think it is really necessary to put them in a cast, but still it's good to allow everything to heal. They are full weight bearing from day one. I tell my patients they can use crutches the first day or two if they need to get sympathy, but they do not need the crutches. In reality, most people use it mainly for pain control for a day or two, but I never see them back at two weeks. Still using crutches. They can do activities as tolerated, so even a stationary bicycle or elliptical trainer within the first few days. In fact, I encourage that. I think the sooner you move, the better the tissue heals. And then the cast comes off for two weeks and sutures out. Then phase two is week three and four. They can do any upper body or core, hip and knee strength, and active range of movement, so they remove the boot as often as often as they want. Do active range of motion. Get the swelling down and get initial mobility and they can increase activities in the gym as tolerated. Again, I encourage them to exercise and get active as soon as possible, but this should be low impact activities, not any strenuous activities. In phase three is week four and six. So then they are out of the camp, but we provide them with an ankle brace to give some sense of security. So they start to official physical therapy. They increase to passive range of motion as well. And now they can do any activity. So eversion, inversion they can bike, they can walk on a treadmill without the boot. If it's in a situation where they have access to ultra G treadmill, they can start to run on a treadmill. And all activity at this point should be guided by the level of pain. If there's minimal pain, you know you're okay. If you do activities that take your pain to a five or a or 6, you need to slow down. Phase four is then week 6 to 8. Then any and all activities is tolerated. Full rehab without restriction so they can start to do cutting and agility activities with the same idea. As long as pain is three or less. Do proprioception activities still use an ankle brace for sporting activities and that's mainly for pain control and swelling. Phase five is week 8 to 9 again full range of motion. At this point they can do single leg balance activities. They can do single leg hopping. They should be near full strength at this point and depending upon the sporting activity, they use a brace or if it's a soccer player or a football player or basketball. I advise them to use a brace. If it's a ballerina or gymnast, they obviously cannot do that with a brace. Still do proprioceptive training. By now, most of these patients will be almost fully recovered. They might have some swelling after activity, but they can do toe raises. They can do lunges and squats, they do hopping and skipping and all the cutting activities that they need to do to play. And then finally, from week ten on, at this point, we hope that they are fully functional and return to work and sporting activity, with the goal to continue to build endurance and work specific or activity specific training. We know that the ligament is not mature at this point. It is healing, but it still takes six months to mature. But because of the internal brace, it can speed through these recovery phases knowing that you will not overstress your repair. That's why I always say take six months to mature. So there might be some background discomfort, but these patients are usually back to full activities and sporting activities by ten weeks.

Augmented Brostrom Post-Op Protocol

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