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Broström Procedure – Lateral Ankle Ligament Reconstruction

Indications for a Lateral Ankle Ligament Reconstruction

The Brostrom procedure is performed to address ankle instability and not pain. It is essentially a reconstruction or repair of the lateral ankle ligaments. Patients requiring a Brostrom procedure will typically have a history of recurrent ankle sprains. Their physical exam will demonstrate increased looseness of the outside (lateral) ankle ligaments. This is often confirmed on x-rays with a stress view.

How is the Brostrom Procedure Performed?

The Brostrom procedure is performed through an incision on the outside (lateral) of the ankle. The incision is opened up down to the ankle joint. The primary restraining ligament (the anterior talofibular ligament) on the outside of the ankle is identified. This anterior talofibular ligament is typically stretched out. The dissection is usually extended down to the tip of the fibula (the prominent bone on the outside of the ankle) where the calcaneofibular ligament is identified. The calcaneofuibular ligament is also often scratched out. The anterior talofibular ligament is tightened. This is done by cutting the ligament and repairing it in a tightened position with strong non-absorbable sutures. This may also be performed on the calcaneofibular ligament if this ligament is also loose. A modification to the Broström procedure may be added. This modified Brostrom procedure is performed by identifying the strong extensor retinaculum and incorporating this tissue into the repair. Following the ligament repair the wound is then closed in a layered manner. In some patients it may be possible to perform the Brostrom lateral ligament reconstruction using arthroscopy.

Recovery from a Brostrom Procedure

Patients undergoing a lateral ankle ligament reconstruction using a Brostrom procedure typically need a 6-week period where the ligaments are allowed to heal. During this time, patients are either non weight-bearing or putting only limited weight through the operated extremity. Patients are sometimes allowed to place the ankle through a gentle range of motion in order to limit the stiffness. Once the surgeon has determined that the repair is strong enough physical therapy is usually started. This therapy program focuses on:

  • Regaining strength about the ankle
  • Regaining motion
  • Improving proprioception
  • Improving gait

For a number of months after surgery, the repair is often protected with an ankle brace (ankle lacer) or equivalent. It is common for patients recovering from a lateral ankle ligament reconstruction to take 4-6 months to be able to return to high-level activities.

Potential Complications of the Surgery

There are some potential risks of surgery that are specific to the lateral ligament reconstruction procedure. This includes

  • Injury to the superficial peroneal nerve: This nerve is often in the wound. The nerve is usually identified and is not normally cut but retracted away from harm. During the retraction, the nerve can be irritated with too much tension. In the repair and healing process, this nerve can become scarred, leading to either decreased sensation over the top of the foot or in some cases, a painful burning sensation in this region. If this type of neuritis occurs, fairly aggressive therapy to desensitize this area is required.
  • Stretching out of the repair: This is another potential risk of this surgery. The repaired ligament is often strong and creates increased stability of the ankle. However, it is not as strong as the original ligament and further ankle sprains will potentially stretch out this ligament. If revision of a Brostrom procedure is required many surgeons will choose to perform a tendon reconstruction of the lateral ankle ligaments or reinforce the repair with an implant that looks a bit like a shoelace and serves to brace the repair internally.

Patients undergoing the surgery are subject to the potential for the usual risks associated with surgery such as the risk of:

This procedure is designed to effectively treat ankle instability. The pain that originates from other sources such as the ankle joint itself will not necessarily be addressed with this procedure.

Edited April 8th, 2024

Previously edited by Tonya Dixon, MD 

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