Ankle Ligament Reconstruction

What is Ankle Ligament Reconstruction?

Ankle Ligament Reconstruction is surgery is performed to re-establish a ligaments bone to bone connection.


Most commonly Lateral Ankle Ligament reconstruction is a surgery to tighten and firm up one or more ankle ligaments on the outside of your ankle. It’s also known as the Brostrom procedure.

When is Ankle Ligament Reconstruction Indicated?

It is very uncommon to need early surgery after an acute ankle sprain. Even Grade 3 sprains have a 70% chance of good recovery without surgery.

This procedure is usually recommended in the case of Recurrent Ankle Sprains or Instability


Benefits of Ankle Ligament Reconstruction

The surgery is performed to:

  • Stop recurrent episodes of rolling the ankle and sprains
  • Improve function so you can move and enjoy daily activities
  • Return to sport and physical activity


Steps of Ankle Ligament Reconstruction Procedure

The procedure is performed:

  • After appropriate diagnostic assessments, pre surgery checks and preparations are complete.
  • In hospital and normally take 1 hour


The procedure is normally performed under a general anaesthetic and  includes the following steps:

  • An arthroscopy is then performed through 2 small (keyhole) incisions at the front of the ankle or over the outside of the ankle where the ligaments have been torn away
  • Tendons behind the ankle are inspected routinely and inflamed tissue is removed (tenosynovectomy) or repaired as necessary.
  • Joint surfaces are inspected, inflammatory and scar tissue is removed, and any bony spurs (osteophytes) are trimmed away.
  • Where Ankle Ligament Reconstructions is required the torn ligaments, muscles, or tendons there are two approaches:
  • Anatomic Repair: involves stretching, shortening and tightening the ligament as needed where stitches or other types of sutures are used to reinforced the overlying tissue (modified Bröstrum-Gould repair)
  • Non-Anatomic Repair: uses a tendon as a graft to replace the damaged or weakened ligaments with a section of tendon derived from the foot and around the ankle and grafted
  • At the end the surgery the incision is closed and the patient is sent to the recovery ward for observation


Preparation for Ankle Ligament Reconstruction Surgery

Once you and your surgeon have decided that surgery is required, preparation is necessary to achieve the best results and a quick and problem free recovery. 


  • Infections - Treat any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
  • Smoking - Stop or cut down smoking to reduce your surgery risks and improve your recovery
  • Weight - Consider losing weight (if overweight) before surgery
  • Medications - refer Medication Information below
  • Fast beforehand - Depending on the type of anaesthesia you'll be receiving, your doctor may advise you to refrain from eating and drinking six to twelve hours before the procedure.
  • Arrange for a ride - You will not be allowed to drive yourself home after the procedure, so make arrangements for someone to pick you up. If you live alone, arrange for someone to check on you that evening or, ideally, to stay with you for the rest of the day.

  • Things to Avoid

    • Stop or cut down on smoking to reduce your surgery risks and improve your recovery
    • Avoid injury (cuts/scratches) to the foot and leg

  • Pre Surgery Tests

    • May be required depending on your other health problems (such as diabetes or heart disease) 
    • Other specialists may need to be consulted to ensure your health during and after surgery is looked after. 

  • Medication Information

    • Blood-thinning medications such as Aspirin and Warfarin may need to be ceased up to 7 days prior to surgery. 
    • Other medications can usually be continued but will need to be discussed with your surgeon

  • Physical & Mental Preparation

    Surgery has a significant impact on both your mental and physical health. You can ensure the best result by:


    • Eating a well-balanced diet.
    • Exercising within the limits of your pain 
    • Considering losing weight (if overweight) before surgery 
    • Treating any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
    • Being prepared to have time off work, hobbies, and your regular daily activities
    • Having support from friends or family 

Returning Home After Surgery

When you go home you need to take special precautions around the house to make sure it is safe. Your post operative plans should include:

  • Mobility or Stability - You may have to accommodate crutches, wheelchair or knee scooter and may need ramps for stairs
  • Sleeping - modify your sleeping arrangements (especially if you are sleeping upstairs) for easy access
  • Access - ensure you have easy access to food, water, medications and any other essentials
  • Showering - You may require rails in your bathroom or a shower chair, and will and a specialised shower bag to keep your foot dry


Assess your home situation to ensure you have adequate home support in the first few weeks following surgery. If you live alone it may be necessary to arrange a package of community care to help during the first few weeks at home.


Ankle Ligament Reconstruction Surgery Process

Some patients with severe or chronic sprains may not be able to return to their prior level of activity. 

  • Day of Surgery

    • You will arrive fast at the hospital at a predetermined time.
    • Please bring all your scans (x-ray, CT, MRI) with you.
    • Please bring all your medications with you.

  • Surgery Recovery

    • You are kept in the recovery room for observation and their vitals are monitored. 
    • You may be required to stay overnight, depending on your pain or in case of complications. 
    • Once your pain is under control and you can mobilise (you may require crutches), you will discharge.
    • Physiotherapy is available to help you mobilise

  • During Surgery

    • The procedure includes the administration of general and/or local anaesthesia, followed by surgical incisions around the ankle. 
    • The ankle ligaments are reconstructed with a combination of sutures and may be augmented with artificial ligament tape. 
    • The wound is stitched up and a dressing is applied.
    • A moon boot is applied to the foot. 

  • Discharge Medications

    • Pain: You will be provided with a script for pain medications
    • Blood Thinners: You may also require a script for a blood thinner (to help reduce the risk of blood clots).
    • Regular Medications: You will be instructed as to whether to recommence your normal medications

Ankle Ligament Reconstruction Rehabilitation Program

  • Weeks 1-2 Post-Op Rehabilitation

    • Elevation is absolutely critical to reducing pain and ensuring the success of your surgery. Keep your foot, ankle, and knee above the level of your heart as much as possible for the first few weeks to reduce swelling. This is most critical in the first few days. Ice may not as helpful because you have thick bandages/dressings.
    • Dressings/ Bandages: Please don’t remove or alter your bandage. Removing your dressings also removes the sterility around the surgical site, and can lead to early wound infection. Some bleeding is normal, but if your bandages become soaked, please let us know, and we can change them for you. 
    • Pain: Continue to use paracetamol, ibuprofen or other pain medications as needed. 
    • Walking/shoewear: Please remain in the moon boot at all times, and limit the amount of walking you do – this will reduce the risk of any wound healing problems. 
    • Weight-bearing: You will be allowed to touch your foot to the ground only, and will require crutches or a knee scooter

  • Weeks 6-12- Post Op Rehabilitation

    • Wound: Your wound should be completely healed. 
    • Pain: Pain levels will continue to improve, and hopefully you will be using very minimal amounts of pain relief. 
    • ï‚·Walking/shoewear: You will be transitioned to your regular shoewear which should be comfortable and supportive. You may gradually return to your normal level of activity. 
    • Driving can also be resumed if you were driving a manual car or your right foot was the one operated on. 

  • Weeks 2-6 Post Op Rehabilitation

    • Wound: Your stitches should have been removed and the wound almost healed. Your surgeon will inform you about whether you may shower/wet the wound. 
    • Pain: Your use of pain medication should continue to reduce
    • Walking/shoewear:  You may begin to do more walking, but still be aware that this may lead to swelling and pain. 
    • Weight-bearing: You will be allowed to increase the amount of weight-bearing but will still require crutches. 
    • Work: Returning to full time or different duties at work will depend on your occupation. Patients can return to work as early as three weeks if they have a desk job and can take up to three months for recovery if their job requires heavy labour. 
    • Driving can also be resumed within 2-3 weeks after surgery (depending on foot-operated and if manual/automatic car)

  • Week 12 and onward Post-Op Rehabilitation

    • You will continue to see improvements in pain, function and swelling over the course of the next 6 months and be getting back to your normal level of function.

Risks & Complications Associated with Ankle Ligament Reconstruction

  • General Risks with Surgery

    • Anaesthetics - Allergic reactions to medications, nausea and vomiting. Your anaesthetist will be able to discuss with you further
    • Blood Loss -Blood loss is typically minimal during surgery and the risk of requiring a transfusion is very low 
    • Surgical Injury - When having surgery there is the risk that nearby structures (e.g. nerves, arteries) can be damaged in the process. 
    • Blood Clotting - Blood clots can form in the leg’s calf muscles causing Deep Venous Thrombosis (DVT) and can travel to the lung (Pulmonary Embolism). These can occasionally be serious and even life-threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon. The risk of clots is reduced by blood-thinning medications and other means.  
    • Infection – The risk of infection is around 1%. This can range from superficial wound infection to deep infection, Treatment can also range from a course of oral antibiotics or require hospital admission with multiple surgeries and removal of hardware. Very rarely infection can lead to systemic illness, loss of limb or loss of life. 
    • Death Due to Surgery - Serious medical problems can lead to ongoing health concerns (heart problems, kidney failure, pneumonia, bladder infections), causing prolonged hospitalization and in rare cases death.
    • Delayed Healing - Some patients take longer to heal than others, particularly people with diabetes or heart disease 
    • CRPS (Complex regional pain syndrome) – A condition where you may experience numbness, burning, pain, sensitivity, altered sweating, temperature intolerance. It is caused by altered nerve response and can range from mild to severe and require a pain specialist consultation. 
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    Specific Risks with Your Surgery

    As with any surgery, ankle ligament surgery involves certain risks and complications. 

    They include:


    • Infection
    • Nerve damage 
    • Unresolved pain and swelling 
    • Ankle stiffness
    • Ongoing instability

    In rare cases, a second surgery may be necessary to correct the problems.

Surgical Follow Ups

  • 1-2 Weeks After Surgery

    • Check-Up with Surgeon
    • Wound review 
    • Suture removal
    • Redressing of wound

  • 12 Weeks After Surgery

    • Check-Up with Surgeon
    • Wound review 
    • Ongoing physiotherapy

  • 6 Weeks After Surgery

    • Check-Up with Surgeon
    • Wound review 
    • Transition to regular shoe
    • Commencement of physiotherapy if required

  • 6-12 Months After Surgery

    • Check up with surgeon only if ongoing problems or questions

How Can I Minimise Post Operative Complications?

  • Elevation - Keeping your foot/ankle elevated above your heart when sitting and sleeping will help with pain, swelling and help wound healing
  • Blood clots (DVT or PE) - Through early mobilisation, stockings, and medications
  • Pain - Keep on top of pain with regular use of pain medications as directed by your surgeon
  • Dressings - Keep dressings dry and intact
  • Shoewear - Keep your prescribed shoe (heel wedge, moonboot) on as instructed
  • Let us know early if you have any questions or worries


What Are the Consequences of Surgery? 

Sometimes the potential risks and consequences of your surgical procedure need to be weighed against the benefits of a successful surgical outcome.


These benefits can include:

  • Freedom from pain
  • Increased movement
  • Greater flexibility
  • Maintained independence
  • Improved outlook
  • Longer more enjoyable life