The Broström procedure is a surgical technique commonly used to repair chronic lateral ankle instability (CLAI), a condition often caused by repeated sprains of the ankle ligaments. The lateral ankle ligaments, including the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), play a crucial role in maintaining the stability of the ankle joint. When these ligaments are stretched or torn, it can lead to ongoing instability, making it difficult for patients to perform daily activities or engage in sports.
How Common It Is and Who Gets It? (Epidemiology)
Chronic lateral ankle instability is a common condition, particularly in active individuals or athletes who have experienced repeated ankle sprains. It affects approximately 15-20% of individuals who experience their first sprain and can be particularly prevalent in individuals engaged in sports like basketball, soccer, or running.
Why It Happens – Causes (Etiology and Pathophysiology)
CLAI typically occurs when the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are repeatedly stretched or torn, leading to instability. This condition is often a result of multiple ankle sprains, trauma, or improper healing from a previous injury, which weakens the ligaments and makes the ankle more prone to further damage.
How the Body Part Normally Works? (Relevant Anatomy)
The lateral ankle ligaments, particularly the ATFL and CFL, stabilize the ankle and prevent excessive movement. These ligaments help control the foot’s position during walking, running, and standing, ensuring that the ankle remains stable and functional. When these ligaments are damaged, the foot may roll inward, leading to instability and difficulty bearing weight.
What You Might Feel – Symptoms (Clinical Presentation)
Individuals with lateral ankle instability often experience:
- Frequent ankle sprains or twisting.
- Pain or swelling on the outside of the ankle.
- Difficulty walking on uneven surfaces or engaging in sports.
- A feeling of the ankle giving way during physical activity.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis of CLAI involves:
- Physical examination to assess ligament stability and joint function.
- X-rays to rule out fractures or other bone issues.
- MRI or ultrasound to assess the condition of the ligaments and soft tissues.
Classification
The Broström procedure is typically performed for:
- Chronic lateral ankle instability due to repeated sprains and damage to the ATFL and CFL.
- Severe cases that do not respond to conservative treatments like bracing or physical therapy.
Other Problems That Can Feel Similar (Differential Diagnosis)
Conditions that may mimic lateral ankle instability include:
- Osteoarthritis of the ankle joint.
- Peroneal tendon injury or tendinopathy.
- Fractures or stress fractures in the ankle.
Treatment Options
Non-Surgical Care
- Physical therapy to strengthen the muscles around the ankle.
- Bracing or taping to support the ankle during movement.
- Rest and ice to reduce inflammation and allow healing.
Surgical Care
- The Broström procedure, which involves repairing the torn ligaments and reattaching them to the fibula for improved stability.
Recovery and What to Expect After Treatment
After the Broström procedure, patients typically wear a boot or cast for several weeks. Rehabilitation is critical, and patients generally start weight-bearing exercises and physical therapy within a few weeks, aiming for a full recovery in 3 to 6 months.
Possible Risks or Side Effects (Complications)
Possible risks of the Broström procedure include:
- Infection or wound healing problems.
- Re-injury or recurrence of ankle instability.
- Stiffness or limited range of motion in the ankle if rehabilitation is not followed properly.
Long-Term Outlook (Prognosis)
The Broström procedure has a high success rate in restoring ankle stability and function. Most patients are able to return to sports and normal activities within 3 to 6 months, especially when InternalBrace™ technology is used.
Out-of-Pocket Costs
Medicare
CPT Code 27698 – Broström Procedure: $149.59
Medicare Part B covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield typically cover this remaining 20%, reducing or eliminating out-of-pocket expenses for Medicare-approved procedures. These plans work with Medicare to fill the coverage gap and minimize your financial responsibility.
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans usually cover any remaining coinsurance or deductibles, which generally range from $100 to $300 depending on your plan and provider network.
Workers’ Compensation
If your Broström procedure is needed due to a work-related injury, Workers’ Compensation will cover all related medical expenses, including surgery and rehabilitation. You will not have any out-of-pocket expenses, as the employer’s insurance carrier will directly pay for all approved treatments.
No-Fault Insurance
If your injury and Broström procedure are related to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and follow-up care. The only potential out-of-pocket cost may be a small deductible or co-payment based on your policy terms.
Example
Sarah Thompson underwent the Broström procedure (CPT 27698) to address her chronic lateral ankle instability. Her estimated Medicare out-of-pocket cost was $149.59. Because Sarah had supplemental insurance through Blue Cross Blue Shield, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the surgery.
Frequently Asked Questions (FAQ)
Q. What is the Broström procedure used for?
A. The Broström procedure is a surgical technique designed to repair chronic lateral ankle instability (CLAI), particularly caused by repeated sprains that damage the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
Q. How is the Broström procedure performed?
A. The procedure involves suturing the torn ligaments and reattaching them to the fibula to restore the stability of the ankle. In severe cases, the Broström-Gould technique may be used to reinforce the ligaments with additional tissue support.
Q. What is the advantage of the InternalBrace™ technology in the Broström procedure?
A. The InternalBrace™ technology involves using a suture tape to augment the repaired ligaments, providing extra strength and preventing them from stretching during the healing process. This modification allows for faster recovery and improved outcomes, especially for athletes.
Q. What is the recovery process after the Broström procedure?
A. Recovery involves wearing a boot or cast for several weeks, followed by rehabilitation. With InternalBrace™ augmentation, patients can begin moving the ankle and bearing weight sooner, typically returning to sports in about 3 months.
Q. What are the risks and complications of the Broström procedure?
A. Risks include infection, wound healing problems, re-injury, and possible stiffness or limited range of motion. However, complications are rare, and most patients recover well with appropriate care.
Q. How soon can I return to sports after the Broström procedure?
A. Most patients can return to sports or regular physical activity within 3 to 4 months, especially with the use of InternalBrace™ technology, which accelerates rehabilitation.
Q. What is the success rate of the Broström procedure?
A. The success rate is generally high, with most patients experiencing significant pain relief, improved stability, and return to normal activities. Some studies show a success rate of over 90%.
Q. How long does the Broström procedure take?
A. The surgery typically takes about 1 to 2 hours, depending on the complexity of the ligament damage and the specific surgical technique used.
Q. Is physical therapy necessary after the Broström procedure?
A. Yes, physical therapy is essential to regain strength, flexibility, and stability in the ankle. It helps prevent stiffness and ensures a full recovery by improving range of motion and muscle strength.
Q. Will I need to wear a cast after the Broström procedure?
A. Yes, you will likely need to wear a walking boot or cast for several weeks after surgery to protect the ankle and allow the ligaments to heal properly.
Q. Can the Broström procedure be done on both ankles at the same time?
A. While it is technically possible to perform the procedure on both ankles at the same time, it is generally recommended to treat one ankle at a time to allow for proper healing and rehabilitation.
Q. Is the Broström procedure suitable for everyone with ankle instability?
A. The Broström procedure is most effective for individuals with chronic lateral ankle instability, particularly those who have had repeated ankle sprains. It may not be suitable for patients with severe arthritis or extensive bone damage.
Q. How long does it take to regain full function after the Broström procedure?
A. Full recovery typically takes 4 to 6 months, with most patients returning to normal activities within 3 months, depending on the severity of the instability and adherence to rehabilitation.
Q. Can the Broström procedure fail or result in recurrent instability?
A. While rare, the procedure can fail if the ligaments do not heal properly or if the ankle is re-injured. Factors such as poor post-surgical rehabilitation or returning to activities too soon can contribute to recurrence.
Q. Are there non-surgical alternatives to the Broström procedure?
A. Non-surgical treatments include physical therapy, bracing, and rest. These treatments are typically recommended for mild cases of ankle instability but may not be effective for severe or chronic instability. Surgery is often the best option when conservative treatments fail.
Summary and Takeaway
The Broström procedure is highly effective for patients suffering from chronic lateral ankle instability. With the added benefit of InternalBrace™ technology, the procedure provides fast recovery times, improves ankle stability, and allows many patients to return to their normal activities, including sports, in just a few months.
Clinical Insight & Recent Findings
A recent study followed 62 patients under 35 years old who underwent the modified Broström procedure (MBP) for chronic ankle instability, with three years of monitoring. About 82% successfully returned to their pre-injury sports level, but 18% continued to face limitations.
Key predictors of poor return to sports included residual pain, recurrence of ankle instability, and poor recovery of dynamic balance control. Notably, all professional athletes in the study regained their prior performance, while some recreational athletes struggled to return.
The findings stress the importance of targeted rehabilitation programs that focus not only on ligament healing but also on pain management and postural control to maximize sports recovery. (“Study on return to sports after the Broström procedure – see PubMed”)
Who Performs This Treatment? (Specialists and Team Involved)
The Broström procedure is typically performed by orthopedic surgeons specializing in foot and ankle surgery. The surgical team may also include physical therapists to assist with post-operative rehabilitation.
When to See a Specialist?
If you experience frequent ankle sprains or persistent instability despite bracing and rehabilitation, it is important to consult with an orthopedic specialist to discuss whether surgical intervention like the Broström procedure is necessary.
When to Go to the Emergency Room?
Seek emergency care if:
- Severe pain at the surgical site.
- Signs of infection such as fever or swelling.
- Inability to bear weight on the affected foot after surgery.
What Recovery Really Looks Like?
Recovery involves wearing a boot for a period of time followed by physical therapy to regain strength, flexibility, and stability in the ankle. Full recovery typically takes 3 to 6 months, and high-impact activities should be avoided until the ankle has fully healed.
What Happens If You Ignore It?
If left untreated, chronic ankle instability can lead to recurrent sprains, chronic pain, and long-term disability. It can also increase the risk of developing arthritis in the ankle joint.
How to Prevent It?
Prevention includes:
- Strengthening exercises to improve ankle stability.
- Wearing proper footwear to reduce the risk of spraining the ankle.
- Using braces or supports during high-risk activities.
Nutrition and Bone or Joint Health
Adequate calcium, vitamin D, and protein intake is essential for maintaining healthy bones and joints, which can support the recovery process after ankle surgery.
Activity and Lifestyle Modifications
Post-surgery, patients should avoid high-impact activities until the foot heals. Gradually resuming physical activities, with the help of physical therapy, will restore strength and flexibility.
Dr. Mo Athar
