Quick answer: Brostrom Gould Ankle Ligament Reconstruction is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Township practices. Call (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle
Last reviewed: May 2026
Quick answer: The Broström-Gould ankle ligament reconstruction restores mechanical stability in chronic lateral ankle instability by anatomically repairing the ATFL and CFL with extensor retinaculum augmentation. It achieves 90–95% return-to-sport rates and is preferred over non-anatomic reconstructions because it preserves ankle motion and proprioception.
Broström-Gould Reconstruction: The Anatomic Advantage
When patients with chronic ankle instability need surgery, there are two philosophical approaches: anatomic reconstruction (repair the original ligaments in their original location) or non-anatomic reconstruction (use a tendon graft routed through bone tunnels to create new stabilizers). The Broström-Gould procedure takes the anatomic route — and for most patients under 50 with sufficient ligament tissue, it is the superior choice.
The reason anatomic repair wins: it preserves the proprioceptive nerve fibers embedded in the native ligament, maintains normal ankle kinematics, and avoids sacrificing healthy tendon tissue for the graft. Non-anatomic procedures (like the Evans and Watson-Jones procedures) alter the normal biomechanics of the subtalar joint, often causing long-term stiffness and arthritic changes that the Broström-Gould avoids.
Key takeaway: Anatomic repair (Broström-Gould) preserves proprioception and normal joint kinematics. Non-anatomic tenodesis procedures alter subtalar mechanics and are now reserved for cases where native tissue quality is insufficient.
Anatomy of the Lateral Ankle: What Gets Repaired
The lateral ankle has three ligaments. The two most commonly involved in chronic instability are:
- Anterior talofibular ligament (ATFL): Runs from the fibula forward to the talus; prevents anterior displacement of the talus; torn in 65–85% of all ankle sprains; the primary ligament addressed in Broström-Gould
- Calcaneofibular ligament (CFL): Runs from the fibula downward to the calcaneus; resists inversion; torn in combination with ATFL in 20–40% of significant sprains; addressed when instability is present in both ankle and subtalar joints
- Posterior talofibular ligament (PTFL): Rarely torn except in complete dislocations; not typically addressed in Broström-Gould
When Broström-Gould Is Chosen Over Reconstruction With Graft
The decision between primary repair (Broström-Gould) and augmented reconstruction with allograft depends on several factors we assess at preoperative consultation:
- Tissue quality: If MRI shows reasonable ligament substance (even if elongated), primary repair is feasible. Severely attenuated or absent ligaments require graft augmentation.
- Activity level: High-demand athletes in cutting sports (soccer, basketball, football) may benefit from augmentation to add strength. Recreational athletes and active non-athletes do equally well with primary repair.
- Generalized ligamentous laxity: Patients with Ehlers-Danlos syndrome or hypermobility spectrum disorder have lower success rates with primary repair alone and usually need graft augmentation or internal brace augmentation.
- Revision surgery: Failed prior Broström repair typically requires augmentation with allograft or InternalBrace™ augmentation (suture tape device).
InternalBrace™ Augmentation: The Modern Addition
A newer development in ankle ligament surgery is the InternalBrace™ technique (Arthrex), which combines the traditional Broström-Gould with a suture tape construct that reinforces the repair while it heals. The suture tape acts like an internal ligament brace — providing immediate structural support that allows accelerated rehabilitation — while the native ligament repair heals underneath it.
A 2022 RCT in AJSM found InternalBrace augmentation significantly improved stability at 6 months and allowed faster return to sport compared to Broström-Gould alone, without compromising long-term function. We use InternalBrace augmentation selectively for patients needing faster return to sport or who have borderline tissue quality.
Key takeaway: InternalBrace augmentation accelerates return to sport after Broström repair and is particularly useful for competitive athletes or patients with borderline tissue quality.
⚠️ Signs conservative care has failed and reconstruction may be needed:
- Ankle instability continues despite 6+ months of PT and bracing
- Multiple sprains per year despite prophylactic ankle bracing
- MRI shows ATFL elongation or rupture with clinical instability
- You’ve had prior repair that failed
- Instability limits work, daily activity, or athletic participation
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 same-day evaluations and advanced in-office care.
Same-day appointments available. (810) 206-1402
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Is the Broström-Gould reconstruction the same as ankle ligament repair?
The Broström-Gould IS an ankle ligament repair — specifically, it directly repairs the native ATFL (and CFL when needed) with augmentation. “Ankle ligament reconstruction” more broadly includes both direct repair procedures like Broström-Gould AND non-anatomic tenodesis procedures using tendon grafts. The Broström-Gould is the most commonly performed and is considered the gold standard for primary surgery.
What is the failure rate of Broström-Gould surgery?
Long-term failure rates (recurrent instability requiring revision) are approximately 5–10% at 10-year follow-up for well-selected primary cases. Risk factors for failure: generalized hypermobility, very high activity demands, poor tissue quality at surgery, and inadequate rehabilitation. Adding InternalBrace augmentation may reduce failure rates in high-risk patients.
Can both ankles be repaired at the same time?
Bilateral simultaneous repair is generally not recommended — it makes post-operative rehabilitation very difficult since both feet would be non-weight-bearing. We typically repair the more symptomatic ankle first, allow full recovery, then address the second ankle if needed. Many patients find that the stability gained on one side improves overall function enough that the second ankle can be managed conservatively.
The Bottom Line
The Broström-Gould reconstruction is the right choice for most patients with chronic lateral ankle instability who need surgery — anatomic, motion-preserving, and proven. With 90%+ success rates and modern augmentation options like InternalBrace, the outcomes are better than ever. Dr. Biernacki at Balance Foot & Ankle performs Broström-Gould procedures routinely and can evaluate whether you’re a candidate at a same-day consultation.
Sources
- Cho, B.K., et al. (2022). Broström repair vs. InternalBrace augmentation RCT. American Journal of Sports Medicine, 50(6), 1573–1581.
- Vuurberg, G., et al. (2018). Diagnosis, treatment and prevention of ankle sprains. British Journal of Sports Medicine, 52(15), 956.
- Dierckman, B.D., & Ferkel, R.D. (2023). Anatomic reconstruction for ankle instability. Foot & Ankle Clinics, 28(1), 1–18.
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What is Foot pain?
Foot pain is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of foot pain include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of foot pain respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from foot pain varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
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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.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)