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Brostrom-Gould Procedure for Lateral Ankle Instability

Eric Bluman, MD, PhD
Brigham and Women's Hospital

Pre-operative care

  • IV antibiotics administered and  popliteal and saphenous nerve block placed

Anatomic Landmarks

  1. Make Anatomic Landmarks

Incision

  1. Incision 4.0 cm Proximal to Tip of Fibula, Curving Towards Sinus Tarsi
    • Incision should be 6cm long curving incision distally and posteriorly around the distal tip of the fibula
    • Must be able to access ATFL and CFL from your incision
  2. Locate Anterior Central Branch of Superior Peroneal Nerve and Retract
    • Also ID and preserve Sural Nerve Posteriorly

Dissection

  1. Identify and Incise Extensor Retinaculum
    • Incise Anterior retinaculum with Metzenbaum scissors. This will be repaired at the end of the case.
  2. 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
  3. Cut ATFL Remnant and Elevate
    • This will later be sewn to Calcaneofibular Ligament (CFL)

Bone Preparation

  1. Debride Anterior Distal Fibula
  2. 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.

Repair

  1. Sew ATFL remnant to CFL with #1 Ethibond Sutures
    • Use Box Stitch technique
    • Foot should be in Dorsiflexion and Eversion
  2. Oversew Repair with #0 Vicryl Sutures
    • Keep Foot in Dorsiflexion and Eversion

Closure

  1. Two Layer Closure

Apply Posterior Splint

  1. Dress Wound and Apply Posterior Splint