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Anterior Talofibular Ligament and Calcaneofibular Ligament Repair Reinforced by Bio-inductive Implants

Taseh, A.; Aslan, L.; Chegini Kord, M. H.; Al Masri, M.; Hedayatzadeh Razavi, A.; Nafisi, N.; O Neill, C.; Toy, K.; Batista, J.; Waryasz, G.; Miller, C. P.; Nazarian, A.; Ashkani Esfahani, S.

2025-09-12 orthopedics
10.1101/2025.09.11.25335447 medRxiv
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BackgroundChronic lateral ankle instability stems from laxity in the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments. While suture repair is standard, added reinforcement is often needed to restore native strength. This study evaluates the biomechanics bio-inductive implant augmentation (Bio-Aug) of suture repair. MethodsEight fresh-frozen human ankle specimens were tested under three ATFL and CFL conditions, including: (1) Intact, (2) Suture-Repair, and (3) Bio-Aug, (BioBrace(R), CONMED Co, Largo, FL). Biomechanical testing included a 500-cycle loading protocol, with creep, primary stiffness, and final stiffness as outcomes. ResultsOnly 32% of Suture-Repair specimens completed all 500 cycles, compared to full completion in other groups (P = .04). Bio-Aug results were comparable to Intact, while Suture-Repair showed lower final stiffness than Bio-Aug (P = .049). The Intact group had the least creep, although Suture-Repair showed high variability. ConclusionBio-inductive implant appears to provide comparable stiffness to native ligaments by reinforcing suture repair.

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