Brostrom-Gould Procedure for Lateral Ankle Instability

0. Preoperative care

• IV antibiotics are administered and popliteal and saphenous nerve block is placed.

1. Anatomic Landmarks

1. Mark Anatomic Landmarks

2. Incision

1. 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.
2. Locate Anterior Central Branch of Superior Peroneal Nerve and Retract
• Also ID and preserve sural nerve posteriorly.

3. 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).

4. 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.

5. Repair

1. Suture 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.

6. Closure

1. Two Layer Closure
2. Dress Wound and Apply Posterior Splint