The majority of patients with an ankle sprain recover well with appropriate rehabilitation. Some 20% continue to have recurrent ankle sprains despite adequate strengthening and balance training. This group would benefit from ligament reconstruction of the ankle.
Unlike some knee ligaments, ankle ligament tears usually heal. However, they heal in an elongated position which gives rise to the potential for dysfunction.
Most ligament reconstructions performed are anatomical (do not alter the normal orientation of the original ligaments). Anatomical reconstructions give the best result in terms of returning to sport and carry a low complication rate as compared to other methods of ligament reconstruction. The most commonly performed anatomical reconstruction is the Brostrom procedure. The aim of this procedure is to shorten the elongated ligaments. The Gould modification to this procedure is often performed as well. It serves to reinforce the repair.
Skin incision for the Brostrom reconstruction
Laxity of the anterior talo-fibular ligament (ATFL) and calcaneo-fibular ligament (CFL)
The Brostrom procedure involves imbrication (tightening) of the lax ligaments
The Gould modification to the Brostrom procedure involves using the inferior extensor retinaculum to reinforce the repair
After surgery, the ankle is protected in a cast or a walking boot for a short period and rehabilitation is restarted. The rehabilitation protocol is very similar to that used for an ankle sprain. Straight-line running can be started at 3 months after surgery and twisting sports can typically commence between 5 to 7 months after the procedure.