What is it?
A Broström procedure or operation is the repair of the ligaments on the lateral or outside of the ankle, that are excessively loose following recurrent ankle sprains . The surgery is designed to address ankle instability by repairing or tightening the anterior talofibular ligament.
This procedure is performed through an incision on the outside of the ankle. The incision is opened up down to the ankle joint. The anterior talofibular ligament is identified and tightened. This is done by cutting the ligament and repairing it in a tightened position with strong non-absorbable sutures. This may also be performed on the calcaneofibular ligament if this ligament is also loose. Should tissue quality indicate, fibular anchors may be used to strengthen the surgery. A “modification” to the Broström procedure may be added by identifying the strong extensor retinaculum and incorporating this into the repair. Following the ligament repair the wound is then closed in a layered manner.
The goal of this procedure is to improve stability to the lateral ankle, improve the ankle mechanics and restore full function.
Risks of the Procedure
Patients undergoing any surgery are subject to risks of infection, wound healing problems, nerve injury, deep vein thrombosis and pulmonary embolism.
There are some potential risks of surgery that are specific to the lateral ligament reconstruction procedure. This includes:
• Injury to the superficial peroneal nerve: This nerve is often in the wound. The nerve is usually identified and is not normally cut. However, in the repair and healing process, this nerve can become scarred, leading to either decreased sensation over the top of the foot or in some cases, a painful burning sensation in this region. If this type of neuritis occurs, fairly aggressive therapy to desensitize this area is required.
• Stretching out of the repair: This is another potential risk of this surgery. The repaired ligament is often strong and creates increased stability of the ankle. However, it is not as strong as the original ligament and further ankle sprains will potentially stretch out this ligament.
What to Expect
Your physician will perform a physical exam to determine the laxity in your ankle. They may confirm this with a stress view x-ray or other imaging.
Wear shorts or loose pants and a t-shirt for surgery.
Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.
If crutches or a walker are needed, please rent or borrow them prior to your surgery.
The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.
You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.
You will typically be non-weight bearing for six weeks after surgery. Do not actively invert your ankle for the first six weeks.
• You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.
Ankle Care & Bathing
• Use your crutches and do not place any weight on your operated leg! This is important!
• Keep your ankle elevated above heart level as much as possible for the first five days, then as needed when symptomatic for up to two weeks. This will prevent painful swelling and promote healing.
• Keep your splint clean and dry all the time.
• It is ok to shower or sponge bathe 2 days after surgery but you must keep your splint clean and dry at all cost! This usually entails wrapping your ankle in a plastic garbage bag to keep it dry.
• To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48-96 hours and then as needed to help control pain and swelling.
• To avoid frostbite, place a towel or t-shirt between the ice pack and your skin.
• It is not necessary to use ice while sleeping.
• We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time.
• Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol.
• While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
• No driving while taking any narcotic pain medication!
• The pain medication may cause some nausea so take it with food.
• The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.
• Watch for temperature > 101.5F, persistent numbness and tingling in the foot, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, blue toes, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
• If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.
Rehabilitation Plan- Exercises
Formal rehabilitation typically begins six weeks after the repair. Physical therapy will focus on regaining range of motion, strength and proprioception. It can take four to six months to return to high level activity. At two weeks, you may begin mat level hip strengthening exercises and submaximal isometrics at the ankle, avoiding active inversion (turning in of the ankle).