Ankle Lateral Ligament Reconstruction: The Broström Procedure Explained

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Township, MI. Last updated April 2026.

Ankle sprains are the most common sports injury — with an estimated 25,000 occurring daily in the United States. While most sprains heal with conservative management, approximately 20–40% of patients develop chronic ankle instability (CAI): recurrent giving way, persistent pain, and ongoing functional impairment despite adequate rehabilitation. For these patients, surgical lateral ligament reconstruction — most commonly the Broström procedure — provides reliable restoration of ankle stability.

Anatomy of the Lateral Ankle Ligaments

Three ligaments comprise the lateral ankle complex. The anterior talofibular ligament (ATFL) is the weakest and most commonly injured, typically damaged in inversion sprains. The calcaneofibular ligament (CFL) is injured in more severe sprains. The posterior talofibular ligament (PTFL) is the strongest and rarely injured. Chronic instability typically involves ATFL laxity alone or combined ATFL/CFL insufficiency.

Chronic Ankle Instability: When Surgery Is Considered

Surgical reconstruction is considered after: (1) at least 6 months of dedicated conservative management (physical therapy, proprioception training, ankle strengthening, bracing) has failed, (2) clinical examination demonstrates mechanical instability (anterior drawer and talar tilt tests), (3) MRI or stress X-rays confirm ligamentous laxity, and (4) the patient has functional limitations and ongoing instability episodes affecting quality of life or athletic participation.

Good surgical candidates are: patients with primary lateral ligament insufficiency (not generalized ligamentous hyperlaxity syndromes), normal hindfoot alignment (a varus hindfoot predisposes to recurrence and may need concurrent correction), and no significant ankle arthritis (which may require a different approach).

The Broström Procedure: Anatomic Repair

The modified Broström-Gould procedure is the gold standard for lateral ankle ligament reconstruction. The technique involves:

• Direct anatomic repair of the attenuated ATFL and, when needed, CFL — the native ligament tissue is imbricated (overlapped and sutured) to restore appropriate tension
• The Gould modification augments the repair with a flap of the inferior extensor retinaculum, reinforcing the repair and providing additional stability
• Performed arthroscopically or through a small open lateral incision
• Does not sacrifice other tendons (unlike older non-anatomic procedures such as the Watson-Jones or Chrisman-Snook, which used the peroneus brevis tendon as a graft)

The anatomic nature of the repair preserves normal ankle kinematics — a significant advantage over tenodesis-based procedures that can limit subtalar motion.

Arthroscopic vs. Open Broström

Arthroscopic Broström uses specialized suture anchors to achieve the same anatomic repair through smaller incisions. It allows simultaneous treatment of intra-articular pathology (synovitis, osteochondral lesions, loose bodies) that frequently accompanies chronic instability — found in up to 60% of cases. Open Broström provides excellent visualization and reliable results with decades of outcome data. Surgeon experience and anatomy guide the approach choice.

Recovery Timeline

Post-operative management follows a predictable rehabilitation progression:

• Weeks 0–2: Non-weight bearing in a splint or cast. Wound care and swelling management.
• Weeks 2–6: Transition to weight bearing in a walking boot. Gentle range of motion exercises begin.
• Weeks 6–12: Transition to lace-up ankle brace and athletic shoe. Progressive strengthening and proprioception training.
• Months 3–4: Return to running and straight-line activities.
• Months 4–6: Return to cutting sports and full athletic participation.

Long-term outcomes for the Broström procedure are excellent — 85–95% good to excellent results in appropriately selected patients, with low recurrence rates at 5–10 year follow-up.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your ankle conditions, our podiatry team at Balance Foot & Ankle can help with expert evaluations and advanced in-office care.

Related Care at Balance Foot & Ankle

Clinical ankle services at our Howell and Bloomfield Township offices.

Ankle Sprain & InstabilityFoot BracingAnkle Arthroscopy