Broström-Gould Procedure – Ankle Stabilization Surgery
The Broström-Gould procedure is a surgical technique used to restore stability to the ankle joint in cases of chronic lateral ligament instability by repairing and reinforcing the damaged ligaments.
Things worth knowing about "Broström-Gould procedure"
The Broström-Gould procedure is a surgical technique used to restore stability to the ankle joint in cases of chronic lateral ligament instability by repairing and reinforcing the damaged ligaments.
What is the Broström-Gould Procedure?
The Broström-Gould procedure is a well-established surgical operation for treating chronic lateral ankle instability. It is classified as an anatomical ligament reconstruction and combines two techniques: the original Broström repair, which involves direct suturing of the damaged lateral ligaments, and the Gould modification, which reinforces the repair using the inferior extensor retinaculum. The procedure aims to restore the mechanical stability of the ankle while preserving its natural range of motion.
Causes and Indications
This procedure is indicated when conservative treatments such as physiotherapy, bracing, or orthotics have failed to adequately address chronic ankle instability. Common underlying causes include:
- Repeated inversion ankle sprains (supination injuries)
- Incompletely healed lateral ligament tears, particularly of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL)
- Chronic mechanical instability with subjective feelings of giving way and functional limitations during daily activities or sports
The procedure is especially common in physically active patients who continue to experience recurrent ankle sprains despite conservative management.
Surgical Technique
The operation is typically performed under regional or general anesthesia. The surgeon makes a small incision over the lateral malleolus to expose the damaged ligaments. The procedure consists of the following steps:
- Broström component: The elongated or torn ligaments (ATFL and, if necessary, CFL) are shortened, imbricated, and reattached or sutured back to the fibula.
- Gould modification: The inferior extensor retinaculum – a band of connective tissue on the front of the ankle – is sutured over the repaired ligaments to provide additional reinforcement.
- Modern variations of the procedure can also be performed arthroscopically (minimally invasive) or as a hybrid approach.
Postoperative Care and Rehabilitation
After surgery, the ankle is initially immobilized in a brace or cast. Rehabilitation typically progresses through several phases:
- Phase 1 (0–2 weeks): Immobilization, elevation, and reduction of swelling
- Phase 2 (2–6 weeks): Gradual weight-bearing with a brace and initiation of physiotherapy
- Phase 3 (6–12 weeks): Progressive mobilization, proprioceptive training, and strengthening exercises
- Phase 4 (from 3 months): Sport-specific training with return to sport expected at approximately 4–6 months
Outcomes and Prognosis
The Broström-Gould procedure is considered the gold standard for anatomical ankle stabilization. Studies report success rates exceeding 85–90% in appropriately selected patients. The majority of patients regain full sporting activity following completed rehabilitation. Complications are rare and may include wound healing issues, nerve irritation, or residual instability.
References
- Broström L. - Sprained ankles. VI. Surgical treatment of chronic ligament ruptures. Acta Chirurgica Scandinavica. 1966;132(5):551–565.
- Gould N, Seligson D, Gassman J. - Early and late repair of lateral ligament of the ankle. Foot & Ankle. 1980;1(2):84–89.
- Vuurberg G et al. - Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine. 2018;52(15):956.
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