Brostrom Ankle Ligament Reconstruction: Surgery for Chronic Lateral Ankle Instability

You are in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what brostrom ankle ligament reconstruction surgery means and what works. Call (810) 206-1402 to book at Howell or Bloomfield Township.

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

What Is Chronic Lateral Ankle Instability?

Chronic lateral ankle instability develops when the lateral ankle ligaments — torn during a significant ankle sprain — fail to heal with sufficient strength to provide normal joint stability. Affected patients experience recurrent ankle sprains with minimal provocation, a persistent sensation of the ankle giving way during walking or athletic activities, and ongoing pain and swelling that limits their activity level.

Approximately 20 to 30 percent of acute lateral ankle sprain patients develop chronic instability. Risk factors include inadequate rehabilitation after the initial injury, repeated sprains before adequate healing, hypermobility syndromes, pes cavus (high arch) foot structure, and return to sport too quickly after injury. When comprehensive conservative treatment — including proprioceptive rehabilitation and bracing — fails to restore functional stability, surgical reconstruction provides reliable, durable results.

At Balance Foot & Ankle, our fellowship-trained foot and ankle surgeons perform the modified Brostrom-Gould procedure — the gold standard for lateral ankle ligament reconstruction — with careful technique tailored to each patient anatomy and activity demands.

Anatomy of the Lateral Ankle Ligaments

Three ligaments provide the primary lateral ankle stability. The anterior talofibular ligament (ATFL) runs horizontally from the fibula to the talus and is the most commonly injured ankle ligament. The calcaneofibular ligament (CFL) runs from the fibula to the calcaneus and provides stability in both dorsiflexion and plantarflexion. The posterior talofibular ligament (PTFL) runs posteriorly and is injured only in severe dislocations.

In most lateral ankle sprains, the ATFL fails first. With more severe injuries, the CFL tears as well. In chronic instability, both the ATFL and CFL are typically attenuated or deficient, with scar tissue replacing the organized ligament structure. Mechanical instability results when this scar tissue fails to provide adequate tensile resistance to inversion stress.

Conservative Treatment Before Surgery

Six months of consistent conservative management is generally attempted before surgical reconstruction unless the instability is severe and the patient is an active athlete who has already undergone appropriate rehabilitation. Conservative treatment includes proprioceptive and neuromuscular training, peroneal muscle strengthening, functional bracing for high-risk activities, and activity modification to prevent recurrent injury.

Patients who respond to proprioceptive rehabilitation often achieve functional stability through improved neuromuscular control even with persistent ligamentous laxity. Surgery is reserved for those who cannot achieve functional stability despite adequate rehabilitation.

The Modified Brostrom-Gould Procedure

The modified Brostrom-Gould procedure — first described by Gould in 1980 as a modification of the original Brostrom anatomic repair — is the standard of care for primary lateral ankle ligament reconstruction. It provides anatomic reconstruction without sacrificing normal tendons, preserves natural ankle mechanics, and achieves excellent long-term outcomes in appropriately selected patients.

Technique

The procedure is performed under regional or general anesthesia with the patient supine or in lateral decubitus position. A curved incision is made anterior to the fibula over the lateral ankle, protecting the sural nerve and peroneal tendons. The inferior extensor retinaculum is identified and preserved for later augmentation.

The attenuated ATFL and CFL are identified. In the original Brostrom repair, the ligaments are imbricated (overlapped and shortened) with sutures to restore appropriate tension. In the modified Gould augmentation, the inferior extensor retinaculum is sewn over the repaired ligaments to reinforce the reconstruction with additional tissue and to improve anterolateral rotational stability.

Modern versions of the procedure may use suture anchors placed in the fibula to secure the repair to bone, providing more reliable fixation than suture-to-soft tissue techniques. The repair is tensioned with the ankle in neutral position and slight eversion to avoid over-constraining the joint.

The peroneal tendons are inspected at the time of surgery and any accompanying peroneal tendon tears or instability are addressed simultaneously.

Arthroscopic Adjuncts

Many surgeons now precede the Brostrom procedure with ankle arthroscopy to address intra-articular pathology that frequently accompanies chronic instability. Osteochondral defects of the talar dome — cartilage injuries caused by repetitive instability episodes — are found in 25 to 95 percent of chronic instability patients in various series. Anterolateral soft tissue impingement from scar tissue is another common finding that can be debrided arthroscopically.

Addressing these intra-articular problems simultaneously provides more comprehensive symptom relief than addressing only the ligamentous instability.

Outcomes of the Brostrom Procedure

The modified Brostrom-Gould procedure achieves excellent outcomes in appropriately selected patients. Long-term studies demonstrate subjective satisfaction rates of 85 to 95 percent, with objective stability restoration in a similar percentage. Return to full athletic activity including competitive sports is achieved by the majority of patients by 4 to 6 months postoperatively.

The procedure is considered the gold standard for primary lateral ankle instability reconstruction because it uses the patient own tissue, avoids donor site morbidity from tendon grafts, preserves normal joint mechanics, and can be successfully converted to a tenodesis (graft-based) reconstruction if it fails — a significant advantage over primary tenodesis procedures that consume the graft tissue on the first attempt.

Recovery After Brostrom Reconstruction

The postoperative protocol varies by surgeon preference and the type of fixation used, but the general progression follows this timeline. Weeks 0 to 2: Non-weight bearing in a splint. Elevation and ice for swelling control. Wound monitoring at the two-week visit. Weeks 2 to 6: Protected weight bearing in a short leg cast or removable boot. Range of motion exercises begin in the boot. Weeks 6 to 10: Full weight bearing in the boot. Physical therapy begins with peroneal strengthening, proprioceptive training, and range of motion restoration. Weeks 10 to 16: Transition to supportive lace-up ankle brace in normal footwear. Progressive return to straight-line jogging. Months 4 to 6: Return to sport-specific agility training. Return to full competitive sports when strength and proprioception testing normalize relative to the contralateral limb.

When the Brostrom Procedure Is Not Appropriate

The Brostrom procedure depends on the quality of the native ligament tissue for its success. In patients with significant ligament attenuation from multiple prior surgeries, connective tissue hypermobility disorders (Ehlers-Danlos syndrome), or neuromuscular conditions causing ankle instability, graft augmentation or alternative reconstructions may be required. Our surgeons discuss all applicable options and their relative merits during the preoperative consultation.

If you experience chronic ankle instability, recurrent sprains, or persistent ankle pain following an ankle sprain, contact Balance Foot & Ankle for a hands-on exam plus imaging when needed. Our foot and ankle surgeons serve patients throughout Southeast Michigan with online booking available 24/7.

Brostrom Ankle Ligament Reconstruction at Balance Foot & Ankle

The modified Brostrom procedure is the gold standard for treating chronic lateral ankle instability. Dr. Tom Biernacki at Balance Foot & Ankle performs this ligament reconstruction to restore ankle stability at our Howell and Bloomfield Township offices.

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

Clinical References

1. Brostrom L. “Sprained ankles. VI. Surgical treatment of chronic ligament ruptures.” Acta Chirurgica Scandinavica. 1966;132:551-565.
2. Gould N, et al. “Early and late repair of lateral ligament of the ankle.” Foot and Ankle. 1980;1(2):84-89.
3. Li X, et al. “Modified Brostrom repair with suture anchors for chronic lateral ankle instability: a systematic review.” Journal of Athletic Training. 2019;54(3):270-280.

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When to See a Podiatrist

Foot and ankle surgery in 2026 is dramatically different than a decade ago — most procedures are now minimally-invasive, outpatient, and allow weight-bearing within days. Balance Foot & Ankle surgeons have performed 3,000+ foot/ankle surgeries with modern techniques. If another surgeon has recommended a traditional open procedure, a second opinion may reveal a faster, less-invasive option.

Call Balance Foot & Ankle: (810) 206-1402  ·  Book online  ·  Offices in Howell & Bloomfield Township

In-Office Treatment at Balance Foot & Ankle

When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced treatment options — including Ankle Sprain & Instability Treatment in Michigan at our Howell and Bloomfield Township clinics.

Book online 24/7. Call (810) 206-1402 or book online.

In-Office Treatment at Balance Foot & Ankle

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