A modified Brostrom is an ankle reconstruction surgery a doctor may recommend for a patient with severely unstable ankles that do not respond to more conservative treatments. In this procedure, a foot and ankle surgeon will shorten ligaments and tendons, and may need to harvest material from another location to replace a badly damaged ligament, depending on the patient's case. After recovery, the patient should feel much more stable, while retaining a normal range of motion in the ankle. Patients can go on to compete in athletic events and engage in a variety of other activities after a modified Brostrom.
When a patient sees a doctor for ankle instability, the early steps of treatment are usually conservative. The doctor may recommend physical therapy, taping, splinting, and bracing to see if these resolve the issue. If it becomes clear that the patient's ankle will not respond to these treatments, surgery is a possible option. A surgical consult will include imaging studies of the ankle to allow the doctor to see what is happening inside the joint, as well as a discussion of available procedures.
In the modified Brostrom, the surgeon makes a small open incision to access the ligaments surrounding the ankle. If they are still in good condition, the surgeon may be able to tighten them up to resolve the instability, anchoring them to part of the joint to make sure they will remain in position. In patients with badly torn or stretched ligaments, donor tissue is necessary. With the Brostrom, the tissue comes from the patient, while in other patients, a doctor may need to use cadaver tissue.
After a modified Brostrom surgery, the patient will wear a splint for several days to allow the surgeon to check on the ankle and control swelling in the early stages of recovery. The surgeon may opt to transition to a cast to keep the ankle in position after that, or could continue with bracing and casting, depending on the situation. Patients will need pain management to control postoperative pain, and physical activity is usually restricted for as much as six months.
Outcomes with a modified Brostrom are variable. Some patients experience a substantial improvement and do not need surgery again. Others may develop instability in the future due to the nature of their work or to factors like having a connective tissue disorder that leads to stretching of the ligaments again. A surgeon may request periodic follow-up appointments to check on the ankle.