Brostrom-Gould Procedure for Lateral Ankle Instability

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