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

From Ankle Sprain to Chronic Instability

Lateral ankle sprains are the most common musculoskeletal injury in active individuals, but “common” does not mean “minor.” Approximately 40% of patients who sustain a significant lateral ankle sprain develop chronic lateral ankle instability (CLAI) — a condition characterized by recurrent giving-way episodes, persistent lateral ankle pain, diminished confidence in the ankle during physical activity, and objective evidence of abnormal talar tilt within the ankle mortise on stress X-rays. CLAI develops when the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) — torn during the original sprain — heal in a lengthened or attenuated position that no longer provides adequate mechanical restraint to inversion-internal rotation stress at the ankle.

Left untreated, chronic ankle instability causes progressive consequences beyond the ankle itself: recurrent sprains progressively stretch the peroneal tendons, the peroneal muscles fatigue and lose their reflexive stabilizing function, articular cartilage on the medial talar dome develops osteochondral lesions from repetitive abnormal impaction during instability episodes, and the lateral ankle osteophytes that form from recurrent periosteal irritation eventually contribute to ankle arthritis. Treatment of CLAI before these secondary changes develop produces the best long-term outcomes.

Rehabilitation First: Who Can Avoid Surgery

The first-line treatment for CLAI is a structured rehabilitation program specifically designed to restore proprioception, peroneal strength, and neuromuscular control at the ankle. This is not generic “ankle exercises” — it is a targeted program including single-leg balance training on unstable surfaces, peroneal eccentric strengthening, sport-specific directional change exercises, and progressive functional loading. Published evidence shows that 60-70% of CLAI patients achieve functional stability without surgery after 3-6 months of dedicated rehabilitation. Athletic peroneal taping during sport, lace-up ankle braces, and proprioceptive training form the conservative management framework.

Surgical intervention is indicated for patients who fail a minimum of three months of dedicated rehabilitation, who experience persistent giving-way episodes limiting their sport and daily activities, who have radiographic evidence of significant talar tilt on stress views, or who have an occupational or competitive sport demand that makes ongoing instability unacceptable.

The Broström Procedure: Anatomy and Technique

The Broström lateral ankle ligament repair, first described in 1966 and refined by Gould in 1980 (the Broström-Gould modification), is the gold standard surgical treatment for CLAI. The procedure directly repairs the attenuated or torn ATFL and CFL by shortening and reattaching them to their anatomic origins on the fibula. Unlike non-anatomic reconstructions (such as the Watson-Jones or Evans procedures that transfer the peroneal tendons) the Broström restores the native ligament anatomy without sacrificing normal tendon function, preserving the proprioceptive nerve endings within the original ligament tissue that are important for ongoing ankle stability.

The Broström-Gould modification augments the repaired ATFL with the inferior extensor retinaculum — a band of fascial tissue on the anterolateral ankle — which is advanced over the repaired ligament and sutured to the fibula, providing a second layer of reinforcement. This modification has largely replaced the original Broström technique because of its superior resistance to re-stretching, particularly in athletes who demand high lateral ankle loads.

The procedure is performed through a curved incision approximately 4cm long over the anterior fibula. The attenuated ATFL is identified, imbricated (folded back on itself to tighten it), and sutured to the fibular periosteum through drill holes or suture anchors inserted into the fibula. Modern suture anchor systems (PEEK or titanium anchors with high-strength suture) provide secure fixation that is resistant to the early mobilization forces of the accelerated rehabilitation protocol, which has replaced the prolonged cast immobilization historically used after Broström surgery.

Arthroscopic Broström Technique

Arthroscopic or all-inside lateral ankle ligament repair has been developed over the past decade as a minimally invasive alternative to open Broström repair. Through two small portals on the anterolateral ankle, a specialized retractor maintains visualization while suture anchors are placed in the fibula and the ATFL tissue is imbricated and secured without a formal incision. Simultaneous ankle arthroscopy allows inspection and treatment of concomitant intra-articular pathology — osteochondral lesions, synovitis, anterolateral impingement — that is present in a significant percentage of CLAI patients.

Early evidence for arthroscopic Broström repair shows outcomes comparable to open surgery with the advantages of smaller incisions, reduced risk of sural nerve injury, faster wound healing, and the ability to address intra-articular pathology in the same procedure. The technique requires specialized instrumentation and surgeon expertise, but is increasingly adopted as the primary approach at centers with the necessary equipment and training.

Recovery and Return to Sport

Recovery from the Broström procedure follows an accelerated protocol with early mobilization. Patients are typically in a splint for one to two weeks, then transition to a walking boot with progressive weight-bearing. Physical therapy begins at two to three weeks for range of motion and progresses to proprioceptive training, peroneal strengthening, and sport-specific exercises. Most patients return to running at 10-12 weeks and to competitive sport at four to six months. Athletes who require cutting, pivoting, or jumping return at the longer end of this range after sport-specific testing confirms adequate dynamic ankle stability.

Outcomes from the Broström-Gould procedure are excellent: published studies show 85-95% return to sport at preinjury level, with maintained stability at 10-year follow-up in the majority of patients. Recurrence rates are low (5-10%) and most recurrences occur in patients who returned to sport prematurely or who have an underlying hyperlaxity condition that was not identified preoperatively.

Balance Foot & Ankle performs the Broström lateral ankle ligament repair at ambulatory surgery facilities serving Livingston and Oakland counties in Michigan. If you have chronic ankle instability that is limiting your sport or daily activities, schedule a consultation at our Howell or Bloomfield Township office. Call (810) 206-1402.

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Expert Ankle Ligament Repair in Michigan

The Broström procedure is the gold standard for chronic lateral ankle instability. Dr. Tom Biernacki performs ankle ligament repair surgery at Balance Foot & Ankle, helping patients return to full activity with a stable, pain-free ankle.

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Clinical References

1. Gould N, et al. “Early and late repair of lateral ligament of the ankle.” Foot Ankle. 1980;1(2):84-89.
2. Bell SJ, et al. “Outcomes after Broström-Gould repair for lateral ankle instability.” Am J Sports Med. 2006;34(5):793-799.
3. Maffulli N, et al. “Return to sport after Broström repair: systematic review.” Br J Sports Med. 2020;54(7):397-404.

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.