Brostrom-Gould Procedure for Lateral Ankle Instability
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Procedure Outline
Table of Contents
- IV antibiotics are administered and popliteal and saphenous nerve block is placed.
- Mark Anatomic Landmarks
- Incision 4.0 cm Proximal to Tip of Fibula, Curving Towards Sinus Tarsi
- Incision should be 6 cm long, curving distally and posteriorly around the distal tip of the fibula.
- Must be able to access ATFL and CFL from your incision.
- Locate Anterior Central Branch of Superior Peroneal Nerve and Retract
- Also ID and preserve sural nerve posteriorly.
- Identify and Incise Extensor Retinaculum
- Incise anterior retinaculum with Metzenbaum scissors. This will be repaired at the end of the case.
- Mobilize Soft Tissues
- Find and Define Anterior Tibiofibular Ligament (ATFL), which runs perpendicular to fibula, about 1 cm proximal to its tip.
- Use a right angle snap to define its borders.
- Cut ATFL Remnant and Elevate
- This will later be sewn to Calcaneofibular Ligament (CFL).
- Debride Anterior Distal Fibula
- Retract Peroneal Tendons Inferiorly to Expose CFL
- Incise the peroneal sheath to identify the peroneal tendons and retract them posterioriy.
- CFL is located on the floor of the peroneal sheath, heading posterolaterally off tip of the fibula.
- Suture ATFL Remnant to CFL with #1 Ethibond Sutures
- Use box stitch technique.
- Foot should be in dorsiflexion and eversion.
- Oversew Repair with #0 Vicryl Sutures
- Keep foot in dorsiflexion and eversion.
- Two Layer Closure
- Dress Wound and Apply Posterior Splint
