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

The Modified Brostrom procedure — formally the Brostrom-Gould technique — is the gold standard surgical reconstruction for chronic lateral ankle instability refractory to rehabilitation. By anatomically repairing the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) with augmentation using the inferior extensor retinaculum, it restores ankle stability while preserving normal anatomy and range of motion.

Indications: When Is Surgery Appropriate?

Chronic lateral ankle instability is defined as recurrent giving way with activity, persistent functional limitation, and objective mechanical laxity after completing a structured 3–6 month rehabilitation program. Candidacy for Modified Brostrom repair requires: at least two episodes of significant giving way, failure of conservative treatment, mechanical laxity confirmed on examination (positive anterior drawer test, talar tilt test, or stress imaging), and no significant ankle arthrosis or hindfoot malalignment complicating the picture.

Patients with underlying cavovarus hindfoot deformity, ligamentous hyperlaxity syndromes, neuromuscular disease, or failed prior Brostrom repair may require different or augmented procedures. Body weight above a threshold (typically BMI >35) and high-demand contact sports participation influence the augmentation strategy.

The Brostrom-Gould Technique

Surgery is performed through a 4–6 cm incision along the anterior-inferior fibula. The ATFL is identified — typically attenuated, elongated, or avulsed from its fibular or talar attachment rather than frankly torn. After mobilizing the ends, the ATFL is imbricated (folded and overlapped) or reattached to the fibula using suture anchors inserted into the bone, reestablishing ligament length and tension.

The Gould modification — the key innovation that improved outcomes over the original Brostrom technique — adds reinforcement by advancing the inferior extensor retinaculum (a thickened band of tissue on the lateral ankle) over the repaired ATFL and securing it to the fibula. This augmentation increases initial repair strength, provides biological reinforcement, and improves the stability of the peroneal tendon retinaculum simultaneously.

The CFL is addressed if stress testing under anesthesia demonstrates significant inversion laxity in addition to anterior instability. Concomitant ankle arthroscopy before the open repair allows evaluation and treatment of associated intraarticular pathology (osteochondral lesions, loose bodies, anterior ankle impingement) found in 40–65% of chronic instability cases.

Arthroscopic Brostrom Variants

Arthroscopic-assisted and all-arthroscopic Brostrom techniques have been developed using suture anchors placed arthroscopically through small portals. These techniques reduce incision size, limit soft tissue dissection, and potentially accelerate early recovery. Meta-analyses show equivalent stability outcomes to open repair at intermediate follow-up, though long-term data for purely arthroscopic approaches are less mature than for the open technique.

Recovery and Return to Sport

Postoperative protocol begins with a non-weight-bearing splint for 2 weeks, transitioning to a walking boot with progressive weight-bearing from weeks 2–6. At 6 weeks, physical therapy begins with range of motion and proprioception exercises; resistance training follows. Most patients return to recreational sports at 3–4 months and competitive sports at 4–6 months, with continued proprioceptive training and functional bracing recommended during the first season of return.

Outcomes

The Modified Brostrom procedure achieves excellent results in 85–95% of appropriately selected patients, with durable stability and return to pre-injury sport level in most series. Recurrent instability requiring revision occurs in approximately 5–10% at long-term follow-up. Outcomes are adversely affected by significant hindfoot varus, ligamentous hyperlaxity, previous failed repair, and high BMI.

At Balance Foot & Ankle, Dr. Biernacki evaluates chronic ankle instability and performs Modified Brostrom repair with arthroscopic evaluation at both Bloomfield Hills and Howell offices. Call (810) 206-1402 to schedule a consultation for persistent ankle instability.

Ankle Ligament Repair — Broström-Gould Procedure

Chronic ankle instability from repeated sprains can be permanently corrected with the Broström-Gould ligament repair. Our podiatric surgeons restore lateral ankle stability so you can return to sports and activities without bracing.

Learn About Ankle Instability Treatment | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Broström L. Sprained ankles. VI. Surgical treatment of chronic ligament ruptures. Acta Chirurgica Scandinavica. 1966;132(5):551-565.
2. Bell SJ, et al. Outcome of modified Broström-Gould repair for lateral ankle instability. Foot & Ankle International. 2006;27(4):277-284.
3. Viens NA, et al. Systematic review of outcomes following the Broström procedure for chronic lateral ankle instability. Foot and Ankle Surgery. 2014;20(4):221-225.

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.