The Brostrom procedure is a common surgical technique designed to treat chronic instability in the ankle joint. This operation aims to restore stability and function to an ankle that repeatedly gives way, a condition often caused by stretched or torn ligaments on the outer side of the foot. It is considered a form of anatomic repair, meaning the surgeon works directly with the patient’s existing ligament tissue. The procedure focuses primarily on tightening the key stabilizing ligaments to prevent future painful sprains and restore normal mechanics to the joint.
Understanding the Need for Ligament Repair
The primary indication for a Brostrom procedure is chronic ankle instability, characterized by the ankle “giving way” during activity or persistent pain following an injury. This mechanical instability usually develops after one or more severe ankle sprains that overstretch or tear the lateral ankle ligaments, particularly the anterior talofibular ligament (ATFL). Once damaged, these ligaments no longer provide adequate static support, allowing the ankle to repeatedly roll or turn inward.
The need for surgery is considered only after conservative treatments have failed to resolve the instability, often after six months or more. Non-operative management typically includes bracing, rest, ice, and dedicated physical therapy to strengthen surrounding muscles and improve balance. If a patient continues to experience functional instability despite rehabilitation, surgical repair becomes a viable option to prevent long-term complications like post-traumatic arthritis. The procedure is most successful in patients who have adequate residual ligament tissue that can be tightened and repaired.
Step-by-Step of the Brostrom Procedure
The Brostrom procedure typically begins with an incision made over the outer side of the ankle joint, near the lateral malleolus. The surgeon dissects through the tissue layers, taking care to protect nearby nerves, such as the superficial peroneal nerve. The goal is to gain access to the stretched or damaged anterior talofibular ligament (ATFL) and, if necessary, the calcaneofibular ligament (CFL).
Once identified, the damaged ligaments are often cut and then sutured back together in a technique called imbrication, which effectively shortens and tightens the lax tissue. The primary repair is performed by anchoring the ligaments directly back to the fibula using strong non-absorbable sutures or small bone anchors. This process restores the proper tension and length to the ligaments, improving the joint’s stability.
A common variation, known as the modified Brostrom or Brostrom-Gould procedure, involves an additional step to reinforce the primary ligament repair. A portion of the inferior extensor retinaculum, a nearby band of connective tissue, is mobilized and sewn over the tightened ligaments, acting as an extra layer of support. While the traditional approach involves an open incision, some surgeons now perform the procedure arthroscopically, using small keyhole incisions and a camera.
Navigating the Post-Surgical Recovery
Recovery following a Brostrom procedure begins with immobilization immediately after surgery, typically in a splint or boot for several weeks. The ankle must remain non-weight bearing during this initial phase to allow the tightened ligaments to begin healing without excessive stress. Pain management and control of swelling, using elevation and cryotherapy, are a focus during these first few weeks.
The progression of weight-bearing is gradual, moving from non-weight bearing to partial, and eventually to full weight-bearing over several weeks. Patients are transitioned into a walking boot around three to six weeks post-operation, beginning to tolerate weight as guided by their surgeon. Active movement of the ankle, specifically avoiding inversion and eversion (side-to-side movements), is restricted for the first six weeks to protect the repair.
Physical therapy is a component of the recovery process, often beginning formally around four to six weeks post-surgery. Rehabilitation initially focuses on regaining the full range of motion, particularly dorsiflexion and plantarflexion, before progressing to strengthening exercises. Later stages of therapy concentrate on restoring proprioception, the body’s sense of joint position, through balance and dynamic exercises. A return to light daily activities can occur within 6 to 12 weeks, but full sports participation typically requires a minimum of four to six months.