The lateral ankle ligament complex comprises the ATFL (most commonly torn), CFL (torn with higher grade sprains), and PTFL (torn only in dislocations). The Brostrom procedure directly repairs the ATFL and CFL back to the fibula with suture anchors; the Gould modification reinforces the repair with the inferior extensor retinaculum. The complex also includes the anterior tibiofibular ligament (part of the syndesmosis) which is injured in high ankle sprains.
| Origin | Lateral malleolus (all three components originate here) |
|---|---|
| Insertion | Talus (ATFL and PTFL) and calcaneus (CFL) |
| Actions | The three lateral ankle ligaments provide graduated lateral ankle stability — ATFL in plantarflexion, CFL in neutral and dorsiflexion, PTFL only in extreme plantarflexion |
|---|
The Ottawa Ankle Rules identify patients requiring radiograph in ankle injuries — malleolar tenderness or inability to weight bear requires X-ray to exclude fracture. Grade III ATFL+CFL tears with chronic instability (positive anterior drawer and talar tilt tests) failing 3-6 months conservative management require surgical Brostrom-Gould repair. Arthroscopic Brostrom has equivalent outcomes to open with faster rehabilitation.
Complete lateral ankle ligament complex insufficiency producing recurrent sprains managed with arthroscopic or open Brostrom-Gould repair.
