Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Dec;13(6):788-796.
doi: 10.1007/s12178-020-09679-z. Epub 2020 Nov 7.

Open Brostrom for Lateral Ligament Stabilization

Kenneth J Hunt  1 , Rebecca Griffith  2
Affiliations
Review

Open Brostrom for Lateral Ligament Stabilization

Kenneth J Hunt et al. Curr Rev Musculoskelet Med. 2020 Dec.

Abstract

Purpose of review: Lateral ankle ligament sprains are one of the most commonly reported injuries in high-level athletes and the general population. Unfortunately, up to 40% of these can go on to develop chronic lateral ankle instability which in the right circumstances requires surgical intervention. The purpose of this review is to present the gold standard surgical treatment for chronic lateral instability with anatomic ligament repair and to highlight the techniques, outcomes, and importance of anatomy when considering surgical treatment.

Recent findings: Recent and remote literature agrees that the initial treatment for chronic ankle instability is non-operative rehabilitation. In the cases where this fails, the gold standard of surgical treatment is open anatomic repair using the Brostrom-Gould technique which stands out as having very good results over the course of time. Recent studies have shown equally good outcomes with arthroscopy as well as with internal brace devices, and both techniques show potential for earlier rehabilitation. In those with contraindications for anatomic repair including innate soft tissue laxity, high BMI, and in the revision setting, anatomic ligament reconstruction is an appropriate surgical option. Open modified Brostrom lateral ligament repair continues to be the preferred method of surgical treatment for chronic lateral ligament instability. In the setting of new modifications and techniques, long-term outcome studies are necessary to identify both their usefulness in long term and to compare them to the open surgery outcomes. It would be useful to standardize rehabilitation protocols as well as return to sport metrics in order to better evaluate outcomes moving forward.

Keywords: ATFL; Ankle instability; Ankle sprain; Brostrom; Lateral ligament repair.

PubMed Disclaimer

Conflict of interest statement

Rebecca Griffith declares that she has no conflict of interest.

Kenneth Hunt declares that he has no conflict of interest.

Figures

Fig. 1
Fig. 1
ATFL tear on MRI
Fig. 2
Fig. 2
CFL tear with osteochondral lesion of the talar dome on MRI
Fig. 3
Fig. 3
Tibial anchor placed for ATFL repair
Fig. 4
Fig. 4
Repair of the ATFL to tibial anchor (author’s preferred technique for operative open lateral ligament repair)
Fig. 5
Fig. 5
Repair of the ATFL to tibial anchor with ligament imbrication and periosteal reinforcement (author’s preferred technique for operative open lateral ligament repair)
Fig. 6
Fig. 6
Repaired ATFL (author’s preferred technique for operative open lateral ligament repair)
See this image and copyright information in PMC

References

    1. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44:123–140. - PubMed
    1. Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA. The epidemiology of lateral ligament complex ankle sprains in National Collegiate Athletic Association sports. Am J Sports Med. 2017;45:201–209. - PubMed
    1. Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017;51:113–125. - PubMed
    1. Shawen SB, Dworak T, Anderson RB. Return to play following ankle sprain and lateral ligament reconstruction. Clin Sports Med. 2016;35:697–709. - PubMed
    1. Chen H, Li HY, Zhang J, Hua YH, Chen SY. Difference in postural control between patients with functional and mechanical ankle instability. Foot Ankle Int. 2014;35:1068–1074. - PubMed