What is lateral ankle ligament reconstruction?

Lateral ankle ligament reconstruction is a surgery to tighten and firm up one or more ankle ligaments on the outside of your ankle. It’s also known as the Brostrom procedure. It’s most often done as an outpatient surgery, so you can go home the same day.

Your ankle is a hinge joint that allows motion up and down and from side to side. Your foot and ankle have several ligaments. These are strong, band-like structures that keep the bones in your ankles and feet tightly connected. On the outer side of your foot, you have several ligaments. These include the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). These help keep your ankle and foot steady when you walk.

If you have had repeated ankle sprains or if you have certain foot deformities, your ligaments can start to get weak and loose. If this happens, your ankle may become unstable.

During lateral ankle ligament reconstruction, the surgeon makes a small cut on the outside of your ankle. This is done while you are under general anesthesia. Then your surgeon tightens one or more of the ligaments on the outside of your foot.

Why might I need a lateral ankle ligament reconstruction?

You might need this surgery if one or more of the ligaments on the outside of your ankle has loosened or stretched. This leads to a condition called chronic ankle instability. It can cause chronic pain, repeated ankle sprains, and an ankle that often gives way when you walk or perform activities.

At first, an ankle sprain may stretch and partially tear your ankle ligaments. This first sprain makes it more likely that you will sprain your ankle again. This is more likely if you did not have the first sprain treated correctly. More sprains may loosen your ligaments even more.

Certain mechanical problems with your foot can make you more likely to develop an unstable ankle, such as:

• Hindfoot varus (heel turns inward)

• Plantar flexion of the first ray

• Midfoot cavus (high arches)

• General looseness of your ligaments. For example, from a health condition, such as Ehlers-Danlos.

You may have already been treated with physical therapy and special foot inserts. A healthcare provider may advise surgery if other treatments for your ankle haven’t worked. It’s not common to need this surgery right after a first ankle sprain.

What are the risks of a lateral ankle ligament reconstruction?

Every surgery has risks. Risks for this surgery include:

• Excess bleeding

• Nerve damage

• Infection

• Stiffness in your ankle joint

• Blood clot

• Complications from anesthesia

• No improvement in your ankle stability

Your own risk for complications depends on your age, the anatomy of your foot, and your general health. Talk with your healthcare provider about any concerns you might have. You can discuss the risks that most apply to you.

How do I get ready for a lateral ankle ligament reconstruction?

Talk with your healthcare provider about how to prepare for your surgery. Ask if you should stop taking any medicines ahead of time, like blood thinners. If you smoke, try to stop smoking before your procedure. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines like aspirin. Also, tell them about any changes in your overall health, like a recent fever.

Before your procedure, you may need imaging tests, such as X-rays or an MRI. You should not eat or drink anything after midnight the night before your procedure.

You may need to plan some changes to your home and activities before surgery. You won’t be able to walk on your foot normally for a while.

What happens during a lateral ankle ligament reconstruction?

There are a number of methods used for lateral ankle ligament reconstruction. Ask your healthcare provider about the details of your surgery. An orthopedic foot surgeon will do your surgery. The surgery may take two or more hours. You can expect the following:

• You will probably get general anesthesia to make you sleep through the procedure or regional anesthesia to numb the involved leg.

• During the surgery, your vital signs, like your heart rate and blood pressure, will be watched carefully.

• After cleaning the affected area, your surgeon will make a cut through the skin and muscle of your ankle.

• If your surgery is minimally invasive, your surgeon will make a small incision. They will put small instruments and a camera through the incision to perform your surgery.

• Your surgeon may remove your ATFL and your CFL ankle ligaments from where they attach on your fibula.

• They may make these ligaments shorter.

• Your surgeon may then reattach these ligaments to your fibula by using small holes drilled into your bone and special suture.

• Your surgeon may make other repairs, if necessary.

• The layers of skin and muscle around your ankle will be surgically closed.

What happens after a lateral ankle ligament reconstruction?

You will be kept track of for a few hours after your surgery. When you wake up, you'll likely have a splint on your ankle. Often, lateral ankle ligament reconstruction is an outpatient procedure. This means you can go home the same day. You should have someone drive you home.

You will have some pain for a while after your surgery, especially for the first few days. Pain medicines may help to relieve your pain. Carefully follow all instructions about medicines and wound care. Keeping your leg elevated may help reduce swelling and pain, too. You’ll probably need to use crutches and keep weight off your ankle for at least a few weeks. Make sure to tell your surgeon right away if you have high fever, chills, or increasing pain from your ankle.

You will need to return in about 10 days after your surgery to have your stitches or staples removed. Your surgeon might also replace your splint with a boot or cast at this time. In a few weeks, your healthcare provider will likely replace this cast with a removable brace. You’ll need to use this brace for several months.

Your healthcare provider will give you specific instructions about how to strengthen your ankle and leg muscles as you recover. You may benefit from physical therapy as well. This will help make sure that your surgery will be a success.

Next steps

Before you agree to the test or procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure