Lateral Ankle Ligament Repair (Brostrom-Gould Procedure)

Type of Procedure: Outpatient

Length of Procedure: 1 hr

Anesthesia: Regional nerve block with general anesthesia or sedation

Medications: Oxycodone or Norco for pain, aspirin 81 mg twice daily for 3 weeks to lower risk of blood clots, ondansetron for nausea

Follow-up appointments: 2 weeks, 6 weeks, 12 weeks

Time Non Weight Bearing: 2 weeks no weight, advance weight bearing in boot from weeks 2-6, transition to shoes 6-8 weeks from, surgery

Time to Driving: When off narcotics for left foot unless you have a clutch, 8-10 weeks for right foot

Ankle Instability: General facts

• Ankle sprains are the most common injury to the ankle
• ~25% of ankle sprains turn into chronic ankle instability
• Patients with chronic ankle instability report ankle giving out with everyday activities, pain on the outside of the ankle, and avoidance of doing some activities due to feelings of instability
• If left untreated, ankle instability can lead to ankle arthritis
• Diagnosis is made based on clinical examination and history; MRI is often obtained to evaluate for associated injuries

Lateral Ankle Ligament Anatomy

• Three ligaments make up the lateral ankle ligament complex (ATFL, CFL, and PTFL)
• ATFL is most commonly injured, followed by the CFL
• The ligaments prevent the ankle from turning inwards
• When injured, they generally heal but if not rehabbed appropriately, can heal in a stretched out position

Treatment Ankle Instability

• Nonoperative treatment includes 6-12 weeks of PT, activity modification, and use of lace-up ankle braces
• Surgery is recommended in patients who have continued pain and feelings of instability despite non-surgical treatment
• Surgery involves an incision over the outside of the ankle
• The ligaments are then cut and tightened before being anchored back to the bone
• If the ligaments are very thin or loose and require reinforcement, Dr. Dean will sometimes reinforce his repair with an internal brace
• Lateral ligament repairs are often done at the same time as surgery on the peroneal tendons and ankle arthroscopy depending on the findings of MRI

Before Surgery:

1. No restrictions
2. You may walk as tolerated in comfortable shoes
3. A lace-up ankle brace or boot may be used for comfort

After Surgery:

1. Immediately after:
   1. In a splint below your knee, keep splint dry
   2. Elevate the leg, ice, take pain medication
   3. No weight (use crutches, walker, knee scooter, or wheelchair)
2. 2 week appointment:
   1. Stitches come out and steri-strips placed
   2. You will go into a boot and begin 50% weight bearing on the operative side
   3. You will progress your weight bearing in the boot over the next 4 weeks so that you are full weight bearing in the boot at your 6 week appointment
   4. Begin moving ankle up and down / avoid side to side motion of the ankle
   5. You will begin PT for range of motion
3. 6 week appointment:
   1. Between 6-8 weeks you may transition from the boot to a supportive gym shoe
   2. May start turning you foot outwards (eversion) and inwards (inversion in therapy at 8 weeks
   3. Begin strengthening at 8 weeks
   4. Continue physical therapy
4. 12 week appointment:
   1. Continue physical therapy to work on strengthening and range of motion
   2. May begin running
   3. May resume high impact activity at 3.5-4 mos if cleared by Dr. Dean