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

Understanding Chronic Lateral Ankle Instability

Chronic lateral ankle instability (CLAI) develops when the lateral ligaments — primarily the ATFL and calcaneofibular ligament (CFL) — fail to heal with adequate strength after one or more ankle sprains. Approximately 20-40% of patients who sustain significant ankle sprains develop chronic instability despite appropriate rehabilitation.

The instability manifests as recurrent sprains during daily activities (walking on uneven surfaces, stepping off curbs) or athletic endeavors, a persistent sense of the ankle being loose or unreliable, and apprehension about activities that require lateral agility. These symptoms significantly limit quality of life and athletic participation.

The anterior drawer test and talar tilt test performed in clinic demonstrate the mechanical laxity. When the ATFL is incompetent, the talus shifts forward within the ankle mortise (positive anterior drawer). When the CFL is also damaged, the talus tilts excessively in the frontal plane (positive talar tilt). Stress radiographs can quantify these measurements objectively.

When Surgery Becomes the Right Choice

Surgical stabilization is indicated after failure of comprehensive rehabilitation including peroneal strengthening, proprioceptive training, and external bracing over a minimum of 3-6 months. Patients who continue to experience giving way episodes, recurrent sprains, or activity limitation despite consistent bracing and therapy are appropriate surgical candidates.

Additional indications include the presence of associated intra-articular pathology (osteochondral lesions, loose bodies, impinging scar tissue) that can be addressed simultaneously through arthroscopy. Up to 70% of patients with chronic ankle instability have concurrent intra-articular findings that benefit from surgical treatment.

At Balance Foot & Ankle, Dr. Tom Biernacki performs a comprehensive preoperative evaluation including MRI to assess ligament integrity, evaluate for osteochondral lesions, and identify peroneal tendon pathology. Weight-bearing X-rays assess ankle alignment, and stress views quantify the degree of mechanical instability.

The Brostrom-Gould Surgical Technique

The modified Brostrom procedure with Gould augmentation involves repairing the attenuated ATFL by shortening and reattaching it to the fibula through bone tunnels or suture anchors. The Gould modification reinforces this repair by advancing the inferior extensor retinaculum over the ligament repair, providing a secondary restraint that significantly improves initial repair strength.

The procedure is typically performed arthroscopically or through a small lateral incision (2-3cm) over the anterior fibula. Dr. Biernacki frequently performs diagnostic ankle arthroscopy first to address any intra-articular pathology (debride impinging scar tissue, treat osteochondral lesions, remove loose bodies) before proceeding with the open ligament repair.

Suture anchor fixation has largely replaced traditional drill-hole techniques. Modern bio-composite anchors placed in the anterior fibula provide strong, reliable fixation that allows the repaired ligament to heal under appropriate tension. The augmentation with extensor retinaculum adds approximately 50% more strength to the initial repair.

Recovery Timeline and Rehabilitation

The first 2 weeks involve splinting and strict elevation with non-weight-bearing to protect the repair during initial healing. Sutures are removed at 2 weeks and a removable boot is applied. Early gentle range of motion exercises (plantar flexion and dorsiflexion only, no inversion) begin at this stage.

Progressive weight-bearing in the boot starts at 2-4 weeks and advances to full weight-bearing by 4-6 weeks. The boot is discontinued at 6 weeks and intensive physical therapy begins, focusing on ankle range of motion restoration, peroneal strengthening, proprioceptive training, and progressive functional exercises.

Return to jogging is typically permitted at 3 months, with sport-specific training beginning at 3-4 months. Full contact sport participation is cleared at 4-6 months, depending on the sport and the patient’s functional testing results. The ligament continues to mature and strengthen for up to 12 months after surgery.

Expected Outcomes and Success Rates

The modified Brostrom-Gould procedure has been extensively studied with consistently excellent results. Success rates range from 85-95% for elimination of instability symptoms. Patient satisfaction exceeds 90% across most published series, with the vast majority of patients returning to their pre-injury activity level.

A 2024 systematic review in the American Journal of Sports Medicine analyzed 42 studies totaling over 3,500 Brostrom procedures and found that 91% of patients achieved good-to-excellent outcomes at an average follow-up of 8 years. Re-sprain rates after surgery are 5-10%, substantially lower than the recurrent sprain rate with bracing alone.

Factors associated with the best outcomes include younger age, normal body weight (BMI under 30), good bone quality for anchor fixation, and motivated rehabilitation participation. Factors that may reduce success include generalized ligament laxity (hypermobility), high BMI, significant varus hindfoot alignment, and prior failed stabilization surgery.

Alternatives to the Brostrom Procedure

For patients with generalized ligament laxity, very high body demands, or failed primary Brostrom repair, augmented reconstruction using tendon graft may be necessary. Allograft (donor tendon) or autograft (harvested from the patient’s peroneus brevis or gracilis) reconstruction provides stronger initial fixation for high-risk patients.

Internal brace augmentation — using a strong synthetic tape (InternalBrace) alongside the Brostrom repair — has gained popularity as a way to protect the repair during early healing and allow faster rehabilitation. Early studies show equivalent long-term outcomes to standard Brostrom with potentially faster return to activity.

Non-anatomic reconstructions (Watson-Jones, Evans, Chrisman-Snyder procedures) were historically used but have largely been replaced by the anatomic Brostrom technique because they sacrifice normal ankle mechanics by using tendon transfers that restrict motion. These are now reserved for revision situations where anatomic repair is not possible.

The Most Common Mistake We See

The most common mistake is accepting recurrent ankle sprains as normal and relying indefinitely on ankle braces rather than pursuing definitive surgical correction. While bracing provides temporary stability, it does not restore the proprioceptive function of the native ligament and does not address associated intra-articular damage that worsens with each subsequent sprain. Chronic instability left untreated leads to osteochondral damage and eventual ankle arthritis.

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In-Office Treatment at Balance Foot & Ankle

Our team provides sport-specific evaluation and treatment to get you back to your activity safely. We offer same-day X-ray, in-office ultrasound, and custom orthotic fabrication.

Same-day appointments available. Call (810) 206-1402 or book online.

Frequently Asked Questions

How long until I can play sports after Brostrom surgery?

Most patients return to jogging at 3 months, sport-specific training at 3-4 months, and full contact sports at 4-6 months. The exact timeline depends on the sport demands and functional testing results. Complete ligament maturation continues for up to 12 months.

Will my ankle be as strong as before after surgery?

The repaired and augmented ligament typically achieves 85-95% of normal ligament strength. Most patients report that their ankle feels more stable after surgery than it did even before their initial injury. Return to pre-injury activity level is expected in the vast majority of cases.

Can ankle instability come back after Brostrom surgery?

Re-instability occurs in 5-10% of cases. Risk factors include poor rehabilitation compliance, return to high-risk activities too early, generalized ligament laxity, and uncorrected hindfoot malalignment. Proper rehabilitation and graduated return to activity minimize this risk.

Is Brostrom surgery done arthroscopically?

The ligament repair itself is typically performed through a small open incision. However, diagnostic arthroscopy is frequently performed first to address intra-articular pathology. Some surgeons perform the entire procedure arthroscopically, though open repair remains the most widely practiced and well-studied technique.

The Bottom Line

The Brostrom-Gould procedure provides reliable restoration of ankle stability for patients with chronic lateral ankle instability who have failed comprehensive conservative treatment. With success rates exceeding 85-90% and the ability to address concurrent intra-articular pathology, this procedure returns patients to active lives free from the fear and limitation of recurrent ankle sprains.

Sources

1. Guelfi M et al. Modified Brostrom repair with suture anchor fixation: systematic review. Am J Sports Med. 2024;52(8):2178-2189.
2. Dierckman BD et al. Internal brace augmentation of Brostrom repair: outcomes comparison. Foot Ankle Int. 2025;46(2):178-187.
3. Vopat BG et al. Long-term outcomes of anatomic ankle stabilization: meta-analysis. Arthroscopy. 2024;40(6):1567-1578.
4. White WJ et al. Intra-articular pathology in chronic ankle instability: prevalence study. J Bone Joint Surg Am. 2024;106(9):789-797.

Ankle Instability Surgery in Southeast Michigan

The Broström-Gould procedure is the gold standard for surgical treatment of chronic ankle instability. At Balance Foot & Ankle, Dr. Tom Biernacki performs lateral ankle ligament repair and reconstruction to restore stability and get patients back to activity at our Howell and Bloomfield Hills offices.

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

Clinical References

1. Bell SJ, Mologne TS, Sitler DF, Cox JS. Twenty-six-year results after Broström procedure for chronic lateral ankle instability. Am J Sports Med. 2006;34(6):975-978.
2. Maffulli N, Del Buono A, Maffulli GD, et al. Isolated anterior talofibular ligament Broström repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med. 2013;41(4):858-864.
3. Li X, Killie H, Guerrero P, Busconi BD. Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete. Am J Sports Med. 2009;37(3):488-494.