What is the postoperative protocol for a revision Broström‑Gould lateral ankle ligament reconstruction with internal‑brace augmentation?

Postoperative Protocol for Revision Broström with Internal Brace

For revision Broström-Gould procedures with internal brace augmentation, initiate early weight-bearing (within 1 week) and range of motion exercises while maintaining functional support with a brace for 6 weeks, followed by progressive strengthening and proprioceptive training. 1

Immediate Postoperative Phase (Weeks 0-2)

Weight-Bearing Status:

• Begin early weight-bearing as tolerated within the first week postoperatively, which is a key advantage of internal brace augmentation over traditional repairs 1, 2
• Use bilateral crutches initially to maintain symmetric gait pattern and distribute load evenly 3
• The internal brace provides mechanical superiority that allows this accelerated timeline compared to non-augmented repairs 1, 2

Immobilization:

• Apply a short leg splint or boot with the foot in slight eversion and dorsiflexion 4
• Functional support with a brace is preferred over rigid immobilization, as immobilization should be limited to maximum 10 days if used at all 5
• Avoid rigid casting as it delays functional recovery 5

Range of Motion:

• Restrict all ankle ROM immediately postoperatively for the first 1-2 weeks 6
• This initial restriction is consistent across 100% of internal brace protocols 6

Pain Management:

• Apply cryotherapy during the first postoperative week to reduce pain and swelling 5, 7
• NSAIDs may be used to reduce pain and swelling 5

Early Rehabilitation Phase (Weeks 2-6)

Weight-Bearing Progression:

• Progress to full weight-bearing by weeks 4-6 in a walking boot 6, 1
• Advancement requires: no pain at current load, no increase in edema/effusion, and ability to perform exercises with correct technique 3

Range of Motion:

• Initiate gentle ankle mobilization exercises within the first week once initial restriction period ends 5
• Begin with ankle circles in both directions, 10-15 repetitions, 3 times daily 8
• Progress to active dorsiflexion and plantarflexion within pain-free range 8
• Full ROM should be achieved by weeks 8-10 6

Manual Therapy:

• Manual joint mobilization combined with exercise therapy enhances outcomes and should be incorporated 5
• Manual mobilization provides short-term increases in dorsiflexion ROM and decreases pain 5

Functional Support:

• Continue ankle brace use throughout this phase 5
• Brace is preferred over tape for consistency and patient compliance 5

Intermediate Phase (Weeks 6-12)

Exercise Progression:

• Prioritize closed kinetic chain exercises (wall push-ups, weight shifts) before progressing to open chain movements 7
• Begin isometric strengthening exercises for ankle musculature 5
• Initiate intrinsic foot muscle strengthening: towel curls, toe spreading, toe tapping 8
• Add peroneal strengthening given the common association with peroneal pathology in revision cases 4

Proprioception:

• Begin single-leg balance exercises as soon as full weight-bearing is tolerated 6
• Progress from stable to unstable surfaces 5

Functional Activities:

• Return to single-leg exercises typically occurs around week 8-12 6
• Progression depends on achieving pain-free ROM, adequate strength, and proper gait mechanics 3

Advanced Phase (Weeks 12-16+)

Neuromuscular Training:

• Introduce neuromuscular training and proprioceptive exercises after 12 weeks to restore dynamic stability 7
• Combine strength and neuromuscular training for optimal outcomes 5

Return to Running:

• Return to running typically begins at weeks 12-16 6
• Requires demonstration of: limb symmetry index >90% for strength testing, pain-free full ROM, and normal gait pattern 7, 3

Return to Sport:

• Return to sport is most consistent at weeks 12-16 across protocols 6
• Restrict contact sports and overhead activities until achieving limb symmetry index >90% for strength testing 7
• Mean return to sport in internal brace studies is approximately 84 days (12 weeks) 2

Critical Considerations for Revision Cases

Key Differences from Primary Repair:

• Revision cases have higher risk of recurrent instability and require more conservative progression despite internal brace augmentation 9
• Address any concurrent pathology (hindfoot varus, peroneal tendon lesions) that may have contributed to initial failure 4
• Functional assessment using Karlsson-Peterson scoring and VAS should guide progression 9

Common Pitfalls:

• Avoid overtightening during repair as this increases postoperative stiffness 4
• Do not advance weight-bearing if patient demonstrates pain, effusion, or abnormal gait pattern 3
• Ensure adequate peroneal tendon function as weakness contributes to recurrent instability 4

Monitoring Progression:

• Use patient-reported outcome measures (FAAM, AOFAS Ankle-Hindfoot score) to quantify functional improvement 2, 7
• Document objective criteria (pain level, effusion, gait quality, exercise performance) at each phase before advancing 3
• Single-leg hop test (Limb Symmetry Index) should show >86% return to normal function before sport clearance 2