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 Township, 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 Township, 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 Township 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.

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