Lateral Ankle Ligament Repair/Reconstruction
Edited by Tonya Dixon, MD
The Brostrom procedure is performed to address ankle instability and not pain. Patients 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.
This procedure is performed through an incision on the outside (lateral) of the ankle. The incision is opened up down to the ankle joint. The anterior talofibular ligament is identified. This ligament is typically stretched out. The dissection is usually extended down to the tip of the fibula (prominent bone on the outside of the ankle) where the calcaneofibular ligament is identified. This 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 by identifying the strong extensor retinaculum and incorporating this into the repair. Following the ligament repair the wound is then closed in a layered manner.
Patients undergoing this type of surgery 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 are allowed to place the ankle through a gentle range of motion in order to limit the stiffness. At approximately 6 weeks physical therapy is usually started. This program focuses on:
- Regaining strength about the ankle
- Regaining motion
- Improving proprioception
- Returning the gait to a more normal manner.
For a number of months after surgery, the repair is often protected with an ankle lacer or equivalent. It is common for patients 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 repair is required many surgeons will choose to perform a tendon reconstruction of the lateral ligaments.
Patients undergoing the surgery are subject to the potential for the usual risks associated with surgery such as the risk of:
- Wound healing problems
- Nerve injury
- Deep Vein Thrombosis (DVT)
- Pulmonary Embolism (PE)
- Continued Symptoms / Failure to resolve all of the symptoms.
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 February 12, 2018