Modified Brostrom-Gould Procedure
synonyms:
Brostrom-Gould CPT
- 27698(repair, secondary, disrupted ligament, ankle collateral)
Brostrom-Gould Indications
- Chronic symptomatic lateral ankle instability that has failed to repond to non-operative management including rehabilitation and bracing.
- Acute third-degree ankle sprains (high-level athletes)
Brostrom-Gould Contraindications
- Fixed heel varus (concomitant valgus osteotomy required)
- Severe tibiotalar varus alignment (require valgus distal tibial osteotomy)
- Obesity
- Large athletes (>250 pounds): concomitant Evans repair indicated
- Peroneal weakness (peroneal nerve pasly, Charcot-Marie-Tooth disease)
Brostrom-Gould Alternatives
- Evans procedure: tenodesis of the peroneus brevis tendon to the fibula, by directly suturing the tendon to periosteum or securing the tendon to the posterior fibula through a bone tunnel. Restricts subtalar motion.
- Watson-Jones procedure: reroutes the peroneus brevis tendon from posterior to anterior through the fibula and then back through the neck of the talus and sutured back on itself. Restricts subtalar motion.
- Chrisman and Snook procedure: split peroneus brevis tendon brought from anterior to posterior through the fibula and down to the calcaneus through bone tunnels. Limits ankle and subtalar motion. (Snook GA, JBJS 1985;67Am:1).
- Colville procedure: split peroneus brevis tendon used to reconstruct the ATFL and CFL in an anatomic fashion without limiting subtalar motion. (Colville MR, AJSM 1992;20:594)
- Anderson procedure: plantaris tendon to used anatomically reconstruct both lateral ligaments without limiting subtalar motion (Anderson ME, JBJS 1985;67A:930)
Brostrom-Gould Pre-op Planning / Special Considerations
- Consider concurrent ankle arthroscopy. Up to 95% of patients undergoing surgery for lateral ankle instability may have associated intra-articular pathology. (Ferkel RD, Foot Ankle Int 2007;28:24).
- Strongly consider concurrent lateralizing calcaneal osteotom fro patietns with hindfoot varus deformity (Kuhn MA, Foot Ankle Int 2006;27:77).
Brostrom-Gouls Technique
- Pre-operative antibiotic
- Anesthesia
- Well-padded tourniquet placed high on the thigh
- All bony prominences well padded
- Prep and drape
- Perform ankle arthroscopy and treat any identified patholgy.
- Leg exanguinated with eschmar bandge and tourniquet inflated
- Curvilinear incision along the anterior border of the distal fibula
- Preserve or ligate lesser saphenous vein. Preserve Sural nerve if encountered
- Dissection down to joint capsule along the anterior border of the lateral malleolus, preserving a cuff of tissue on the fibula
- Identify anterior talofibular and calcaneofibular ligaments or their remnents
- Reef/repair ligaments and capsule using 2-0 nonabsorable suture in pants over vest configuration
- Lateral portion of extensor retinaculum identified and mobilized.
- Extensor retinaculum sutured into the cuff of tissue on lateral malleolus reinforcing the repair
- Examine ankle for stability and full ROM
- Irrigate wound
- close
Brostrom-Gould Complications
- Wound breakdown
- Infection
- Sural nerve injury / neuroma
- Instability / Recurrence
- Stiffness / Overtightening
- CRPS
Brostrom-Gould Follow-up
- 91% Good to excellent results at 26 years for the Brostom procedure (Bell SJ, AJSM 2006;34:975)
- Late reconstruction for lateral ankle instability is successful in approximately 85% of patients regardless of the type of reconstruction performed. (Colville MR, JAAOS 1998;6:368)
- 2 weeks post-op: Place in a removable ankle-foot orthosis and begin active exercise program to regain motion and strength. Passive inversion stretching is avoided.
- 6 weeks post-op: Lace-up style ankle brace for daily activities. Progressive resistive and proprioceptive exercises continued for the next 2-4 months.
- 3 months post-op: Cutting and pivoting sports resumed, brace is worn for sports for 6 months.
- Athletes continue to use a brace or taping for sports indefinitely.
Brostrom-Gould Outcomes
Brostrom-Gould Review References
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