Suture Augmentation May Be Beneficial for Patients With Generalized Ligamentous Laxity Undergoing Modified Broström-Gould Repair: A Systematic Review and Meta-analysis.

BACKGROUND: Lateral ankle sprains are the most common lower extremity injury in athletes, most often involving the anterior talofibular ligament (ATFL). Although ATFL repair outcomes are well studied, optimal management for patients with generalized ligamentous laxity (GLL) remains less understood. PURPOSE: To (1) evaluate the radiographic findings, clinical measures, and complications in patients with GLL undergoing modified Broström-Gould repair and to (2) assess the role of suture augmentation in optimizing outcomes. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: During July 2025, the PubMed, EMBASE, and Cochrane library databases were systematically searched to identify studies examining outcomes and complications in GLL patients who underwent modified Broström-Gould repair. RESULTS: Eight studies including 301 GLL patients (309 ankles) and 367 patients (370 ankles) without ligamentous laxity were analyzed. Both cohorts demonstrated postoperative clinical improvement. A significant difference in postoperative talar tilt angle existed only between GLL patients who underwent modified Broström-Gould repair without suture augmentation and patients without ligamentous laxity (mean difference, 2.18°; 95% CI, 0.57°-3.79°; P = .008). GLL patients experienced 53 (17.2%) failures and were 4.79 times more likely to develop recurrent mechanical instability than patients without ligamentous laxity (risk ratio [RR], 4.79; 95% CI, 1.70-13.5; P = .003). Among GLL patients, the absence of suture augmentation was associated with a 2.95-fold higher complication risk compared with patients without ligamentous laxity (RR, 2.95; 95% CI, 1.08-8.01; P = .03). When suture augmentation was performed, no significant difference in complication rates existed between cohorts. CONCLUSION: Patients with GLL experienced significantly higher rates of complication and failure following modified Broström-Gould repair compared with patients without ligamentous laxity. Suture augmentation may lower complication rates in GLL patients, but its effect on failure rates remains undetermined, as no studies directly compared augmented and nonaugmented GLL patients. Importantly, both GLL patients and patients without ligamentous laxity experienced clinical improvements from the modified Broström-Gould repair. While GLL increases the risk of mechanical complications, it should not be considered a contraindication to undergoing the modified Broström-Gould procedure. However, suture augmentation may be beneficial for GLL patients to reduce the risk of complications after undergoing ATFL repair. REGISTRATION: CRD420251182303 (PROSPERO identifier).