Ankle Stabilisation


What is Ankle Stabilisation Surgery? (Bröstrom procedure)

A Bröstrom procedure is performed to stabilise your ankle by repairing the damaged ligaments on the outer (lateral) side of the ankle. It is recommended when there is a feeling of instability, the ankle is lax on examination and the MRI and/or ultrasound show damage to the ligaments.

The ligament that is predominantly affected is the ATFL (anterior talo-fibular ligament) and occasionally the CFL (calcaneo-fibular ligament). This is a common injury following a severe inversion sprain, rolling inwards of the ankle. Not everyone requires the surgery as the vast majority of sprains heal without ongoing instability. Persistent instability despite a period of physiotherapy following injury is an indication for surgery.

Surgery consists of an incision over the ligaments over the lateral (outside) side of the ankle and directly repairing the ligaments with strong non-dissolving stiches. If there are symptoms of pain as well as instability often the inside of the ankle joint will also be inspected with an arthroscope (keyhole surgery). Occasionally there may also be a high ankle sprain (Syndesmosis injury) that would also need to be stabilised. If this is required it will mean a more prolonged recovery and non weightbearing for 6 weeks post surgery.

What are the risks of ankle stabilisation?

The Bröstrom procedure is a quick and effective operation. The majority of surgeries go very smoothly without any major complications.

There may be a degree of pain for approximately 1 month. Persisting pain is very uncommon. It is common for patients to experience swelling around the ankle, which can take several weeks to settle. Occasionally patients experience some transient numbness around the portals (incisions)

Serious complications such as infection and blood clots are very rare.

Persisting stiffness is uncommon, most patients have reduced movement of their ankle on coming out of their moonboot at 6 weeks but this improves over the next month with Physiotherapy.

Re-rupturing the repair is possible but very uncommon. Spraining the ankle again can be very painful as the repaired area is very sensitive for the first year following the surgery.

How long does ankle stabilisation take?

An uncomplicated stabilisation takes about 60 minutes to perform. It will take longer if an arthroscopy is also required. Occasionally additional procedures are also required – tendon repairs or repairing syndesmosis sprains can extend the surgery to approximately 2 hours

Generally, ankle stabilisation is performed as Day Stay Surgery and you may go home the same day as your procedure.

You will need someone to drive you home, and a responsible adult to be with you overnight as you may still be sleepy and require oral pain medications.

What Happens on the day of surgery?

DO NOT EAT OR DRINK from midnight, unless otherwise instructed.

Dr Schluter will meet with you, answer any further questions, check the consent form and mark the operative leg. You will also meet the anaesthetist (specialist doctor) who will be providing the anaesthetic. In most cases the procedure is done under a general anaesthetic. An IV line (drip) will be inserted and you may be given some

What should I expect immediately after the operation?

After the operation you will go to the recovery room where nursing staff will monitor you until you are awake. You are likely to have a cast over your ankle made of plaster of Paris and wrapped in a crepe bandage (known as a backslab) this is to keep the ankle immobilised but you cannot put weight through it so you will be supplied with crutches. I would also recommend hiring a knee scooter if you are required to be non weight bearing for longer than 2 weeks 0800395395

As you wake up you may experience discomfort or a tight/full feeling in the ankle, which should be easily managed with pain medication. Once you are alert, you will be encouraged to get up and mobilise slowly. Once you can mobilise safely you will be ready for discharged home.

What follow up should I expect?

Dr Schluter will review you at a follow up appointment 1- 2 weeks after your surgery. He will review your wounds and remove any sutures that are not dissolvable. You will be able to discuss the findings of procedure, update work certificates and get a prognosis (estimate) of the time to recovery.

At this appointment, Dr Schluter will also discuss your ongoing rehabilitation programme.

How do I look after my ankle when I get home?

For the first 5 – 7 days it is very important to elevate the leg when you are resting. Rest is important to allow the swelling and inflammation to settle. Take the pain relief medication regularly as prescribed.

Because it is immobilised in the backslab, the ankle should not be too painful. You cannot get the cast wet so when showering, you will need to cover the backslab with a plastic bag and tape it securely.

There may be some bruising and swelling, depending on the how big the procedure was. Generally you will have the dressings changed, wound checked and fitted into a moonboot at the first clinic appointment. If it was an uncomplicated stabilisation procedure you should be able to weightbear through the moonboot from this point. You can shower out of the moonboot so long as the wound(s) has a waterproof dressing over it. The wound can be left uncovered from 3 weeks in the shower if it has healed well.

With the exception of showering, leave the moonboot on at all times (including in bed at night) until instructed to take it off, usually at 6 weeks post op.

You cannot drive with a moonboot on the right leg. You can drive with a moonboot on the left leg if you have an automatic car after 3-4 weeks post surgery, but it is not recommended for long trips. Avoid flying for the first 6 weeks if possible because of swelling and risks of blood clots.

My ankle is still swollen, is this normal?

It is quite normal to have swelling, bruising, clicking and discomfort in your ankle for 8 - 12 weeks after the operation. These ongoing symptoms are generally related to the underlying condition of the ankle, the extent of the surgery and the amount of activity you have been doing.

If you are concerned about any of these symptoms please discuss them with Dr Schluter at the clinic visit.

When can I start Physiotherapy and return to sports?

For an uncomplicated ankle stabilisation, Physiotherapy starts after coming out of the moonboot at 6 weeks and consists on working to increase the ankle range of movement, strengthen the muscles in the leg and improve proprioception (balance and coordination).

It is recommended to exercise with an exercycle and/or cross-trainer after 8 weeks post surgery. It is not recommended to try jogging until 4 months post surgery as discomfort and swelling is common if attempted too early. When starting jogging, using a treadmill initially is recommended.

Return to sport such as netball, rugby, league, football and tennis at 6-8 months post surgery should be achievable assuming an appropriate level of fitness.

What if I have concerns after my surgery?

Please do not hesitate to contact Dr Schluter’s rooms or your GP if you develop any of the following:

  • Heavy bleeding from the incision or the incision opening up

  • Sudden severe pain or tenderness at the wound site or in the joint.

  • Swelling in the calf or thigh, especially if associated with pain or heat

  • Redness around the incision that continues to spreads.

  • Temperature higher than 38.5 °C (fever) or chills.

  • Any concerns you may have regarding your recent surgery