Chronic Lateral Ankle Instability: Broström-Gould Repair vs. Ligament Reconstruction

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

Chronic lateral ankle instability (CLAI) affects up to 40% of patients following acute lateral ankle sprains and is defined by recurrent giving-way episodes, functional instability, and failure of 3–6 months of conservative management including rehabilitation. Surgical management centers on anatomic ligament repair (Broström-Gould procedure) or non-anatomic ligament reconstruction for patients with tissue insufficiency or hyperlaxity syndromes.

Anatomy of the Lateral Ligament Complex

The lateral ankle stabilizers consist of three ligaments: the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The ATFL — the weakest and most frequently injured — restrains anterior talar translation and internal rotation at low plantarflexion angles. The CFL restrains subtalar inversion across all ankle positions and is the primary restraint to hindfoot varus. Isolated ATFL insufficiency produces anterolateral instability; combined ATFL + CFL insufficiency produces both ankle and subtalar instability — the latter being critically important to address for lasting surgical success.

Broström-Gould Anatomic Repair

The modified Broström-Gould procedure is the gold standard surgical treatment for CLAI in patients with adequate ligament tissue. The attenuated ATFL is imbricated (shortened and reattached) to the fibular periosteum with suture anchors, restoring anatomic length and tension. Gould’s modification reinforces the repair with the inferior extensor retinaculum — a local tissue augment that adds constraint and addresses any subtalar component. The Broström-Gould preserves normal ankle kinematics, requires no tendon harvest, and allows predictable rehabilitation. Success rates exceed 85–90% at long-term follow-up in properly selected patients.

When Reconstruction Is Required

Patients not suitable for direct repair include those with generalized ligamentous laxity (Beighton score ≥ 4), Ehlers-Danlos syndrome, failed prior Broström repair, severely attenuated ligament tissue, or body habitus generating excessive ligament stress. Non-anatomic reconstruction historically used the peroneus brevis tendon (Chrisman-Snook, Evans procedures) — sacrificing a functional tendon to create a ligament substitute. Anatomic reconstruction with gracilis or plantaris tendon graft through fibular bone tunnels to anatomic attachment sites (Anatomic Reconstruction of Lateral Ankle Ligaments — ARLL) better restores normal biomechanics than non-anatomic procedures and is preferred when reconstruction is necessary.

Arthroscopic Augmentation

Arthroscopic-assisted Broström repair with internal brace augmentation (InternalBrace, Arthrex) has gained popularity — the InternalBrace provides immediate load-sharing with the repaired ligament during the healing phase, allowing earlier return to weight-bearing and activity. Combined with arthroscopic treatment of intra-articular pathology (anterolateral impingement, osteochondral lesions, loose bodies) present in up to 95% of CLAI patients, the all-arthroscopic approach minimizes soft tissue disruption while addressing both the instability and associated intra-articular pathology.

Rehabilitation Protocol

Post-Broström rehabilitation begins with 2 weeks non-weight-bearing in a splint, followed by progressive weight-bearing in a boot at 4–6 weeks, and formal physical therapy targeting proprioception and peroneal strengthening at 6–8 weeks. Athletes typically return to sport at 4–6 months with a functional brace. InternalBrace-augmented repairs allow accelerated protocols with full weight-bearing at 2–3 weeks and return to running at 8–10 weeks.

Ankle Instability Treatment — Balance Foot & Ankle

Dr. Biernacki treats chronic ankle instability with Broström-Gould repair and reconstruction. Serving Bloomfield Hills, Howell, and all of Michigan.

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Frequently Asked Questions

How do I know if I sprained or broke my ankle?

Both cause pain, swelling, and difficulty walking. Key differences: fractures often cause more immediate severe pain, tenderness directly over bone (not just ligament), and inability to bear any weight. X-rays and the Ottawa Ankle Rules help determine if imaging is needed.

How long does an ankle sprain take to heal?

Grade I (mild): 1–2 weeks. Grade II (moderate): 3–6 weeks. Grade III (complete tear): 2–3 months. Chronic instability from improperly treated sprains can persist and may require surgery.

What is the best treatment for a sprained ankle?

RICE protocol (Rest, Ice, Compression, Elevation) for the first 48–72 hours, followed by protected weight-bearing as tolerated. Physical therapy rehabilitation is critical for high-grade sprains to restore strength and proprioception and prevent chronic instability.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Hills offices.

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Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care

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.