Broström Procedure

The Broström procedure works best when the ligaments are stretched but the tissue quality is adequate for direct repair. In patients who have had multiple prior ankle surgeries, in those with generalized ligamentous laxity (hypermobility), or when the ligament tissue has degenerated too much to repair directly, surgeons augment the Broström with a tendon graft (typically from the peroneus brevis or an allograft). The decision is made intra-operatively or pre-operatively based on MRI findings. Pure direct Broström repairs have a 10-15% long-term failure rate; augmented repairs are more durable in high-risk patients.

Many surgeons perform arthroscopy first as a routine part of the procedure, since osteochondral lesions (cartilage injuries on the talus) are found in 40-65% of patients with chronic ankle instability who have imaging. If an unaddressed cartilage lesion is left untreated, it continues to cause symptoms after the instability is corrected. Arthroscopy adds 20-30 minutes to the procedure and increases cost slightly, but addressing both problems in one surgery is generally preferred over returning for a second operation.

A re-sprain after a successful Broström is possible. The repaired ligaments are mechanical structures — they can be re-torn with significant force. Most patients are counseled to use a lace-up brace for high-risk activities (trail running, court sports, skiing) indefinitely, not because the surgical result is weak, but because no ligament — native or repaired — is indestructible. A significant re-sprain after surgery warrants MRI and repeat evaluation. In some cases the repair holds and the symptoms resolve with rehabilitation; in others, revision surgery with tendon augmentation becomes necessary.