Ankle Ligament Repair (Brostrom)

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Expert Patient Guide · Foot & Ankle Surgeon · London & North London

Lateral Ankle Ligament Repair Surgery in London

A patient information guide by Mr Matthew Welck — Consultant Orthopaedic Foot & Ankle Surgeon, RNOH Stanmore & North London

At a Glance: Lateral Ankle Ligament Repair

Procedure	Lateral ankle ligament repair — surgical reconstruction of the torn or stretched anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), most commonly using a modified Broström technique, sometimes augmented with an internal brace.
Indication	Chronic ankle instability with recurrent giving-way, persistent pain or sports limitation following ankle sprains, where physiotherapy and bracing have failed.
Most Common Cause	Repeated lateral ankle sprains, typically in football, rugby, netball, basketball, running and racquet sports.
Hospital Stay	Day case or one overnight stay.
Recovery	Non-weight-bearing 0–2 weeks; crutch weight-bearing in plaster 2–4 weeks; crutch weight-bearing in boot 4–6 weeks; physiotherapy 6–12 weeks; return to running 3–4 months; return to pivoting sport 4–6 months.
Outcomes	85–95% good-to-excellent results, with most patients returning to their previous level of sport.
Surgeon	Mr Matthew Welck — Consultant Foot & Ankle Surgeon, RNOH Stanmore & UCL. Private clinics in London, North London and Hertfordshire.

Mr Matthew Welck is a Consultant Orthopaedic Foot and Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH) Stanmore and Honorary Associate Clinical Professor at University College London (UCL). His NHS and private practice covers North London, Central London, Hertfordshire and the wider Greater London area, with national and international referrals for complex cases. With more than 50 peer-reviewed publications, he specialises in total ankle replacement, sports injuries of the foot and ankle, complex hindfoot reconstruction, and lateral ankle ligament repair. This patient information guide explains what lateral ankle ligament repair involves, what recovery looks like, and the risks to consider.

Why Have Lateral Ankle Ligament Repair Surgery?

Lateral ankle ligament repair is one of the most effective surgical treatments for chronic ankle instability following recurrent ankle sprains. It is considered when non-operative measures — physiotherapy, peroneal strengthening, proprioceptive rehabilitation, bracing, taping and activity modification — no longer control symptoms or restore confidence in the ankle.

Chronic lateral ankle instability typically develops after a significant ankle sprain (or repeated sprains) in which the anterior talofibular ligament (ATFL), and sometimes the calcaneofibular ligament (CFL), have failed to heal at their correct length. The ankle then feels persistently weak, gives way unexpectedly on uneven ground, and is prone to further sprains — particularly during sport. Left untreated, recurrent instability can lead to cartilage damage and early ankle arthritis.

The key benefits of lateral ankle ligament repair include:

Significant and lasting reduction in episodes of giving-way and re-sprain
Restoration of confidence on uneven ground, stairs and slopes
Reliable return to recreational, amateur and professional sport — including football, rugby, netball, basketball, running, tennis and skiing
Reduced long-term risk of cartilage damage and post-traumatic ankle arthritis
Improved overall function and quality of life for patients with previously sport-limiting instability
Compatibility with concurrent treatment of associated problems such as peroneal tendon tears, osteochondral lesions of the talus or impingement

Why it matters: Untreated chronic lateral ankle instability accelerates cartilage wear inside the ankle joint. Surgical repair — most commonly a modified Broström procedure, often augmented with an internal brace — restores the natural restraints to the ankle and has been shown to allow most patients to return to their previous level of sport. As a foot and ankle surgeon with a specialist interest in sports injuries, Mr Welck routinely treats patients ranging from weekend athletes to professional sportsmen and women in London and North London.

Preparing for Surgery

Thorough preparation makes recovery smoother and reduces the risk of complications. Before admission you will:

Attend a pre-operative assessment to confirm fitness for anaesthesia and surgery
Be advised to stop smoking — smoking significantly increases the risk of wound complications and slows ligament and tendon healing
Review your medications, as some (including blood thinners and certain rheumatology drugs) may need to be paused
Optimise weight, blood pressure and diabetic control where relevant

Practical preparation at home is equally important. Recommended equipment to consider purchasing before surgery includes:

A foam leg-elevation cushion — keeping the foot above the level of the heart for the first two weeks dramatically reduces swelling, settles bruising and aids wound healing
A waterproof cast or dressing protector (for example, the LimbO waterproof protector) — this allows you to shower safely while in plaster, after the first 2 weeks
Crutches (provided by the hospital)
Loose-fitting trousers and a comfortable shoe for the unoperated foot
A clear, uncluttered walking route between your bed and the bathroom, with trip hazards removed
A friend or family member able to support you for the first 1–2 weeks

For more detailed pre-operative advice, please see our patient leaflets: Preparing for Foot Surgery (PDF) and Recommended Products Guide (PDF).

What Does the Surgery Involve?

Lateral ankle ligament repair is usually performed under a general anaesthetic, with a local nerve block, to eliminate pain straight after surgery. A tourniquet is normally applied to the thigh to reduce bleeding during the operation, and most patients have the procedure performed as a day case.

In simple terms, the surgeon:

Makes a small curved incision on the outer side of the ankle, just below and in front of the bony prominence (lateral malleolus)
Carefully moves the small nerves to the side to protect them
Identifies the torn or stretched anterior talofibular ligament (ATFL) and, where indicated, the calcaneofibular ligament (CFL)
Tightens and reattaches the ligaments back onto the fibula bone using strong stitches and small bone anchors — this is the modified Broström technique
Where extra strength is needed (for example, in elite athletes, ligament-laxity patients, or revision cases) reinforces the repair with an internal brace — a strong synthetic tape that protects the repair while it heals
Closes the wound in layers with absorbable sutures and a waterproof dressing

Additional small procedures — such as repair of a peroneal tendon tear, treatment of an osteochondral lesion of the talus, or removal of anterior ankle impingement bone spurs — may be performed at the same time. Total surgical time is typically 45–90 minutes.

Modified Broström with Internal Brace augmentation: Mr Welck routinely augments the modified Broström repair with an internal brace where indicated. This synthetic tape acts as a secondary safety belt during the early healing phase, allowing earlier rehabilitation and earlier return to sport without compromising the strength of the underlying ligament repair.

How Long Will You Be in Hospital?

Most patients undergo lateral ankle ligament repair as a day case and go home the same day. A short overnight stay is occasionally needed where surgery has been more extensive or where home support is limited. You will be ready to be discharged once you:

Have your pain well-controlled with oral medication
Can transfer safely in and out of bed
Can mobilise a short distance non-weight-bearing on crutches
Have been reviewed and cleared by the physiotherapy team
Are medically stable from a general health perspective

You will go home in a below-knee plaster backslab or boot, with a prescription for blood-thinning injections (anticoagulation) to reduce the risk of deep vein thrombosis (DVT).

What Does Recovery Look Like?

Recovery follows a structured rehabilitation protocol specific to lateral ankle ligament repair, consistent with the post-operative pathways used at RNOH Stanmore and within Mr Welck’s private practice. The exact timeline may be adjusted depending on whether an internal brace has been used, what additional procedures were performed, and the patient’s sporting goals.

Early Phase (0–6 weeks)

Strict elevation of the leg for the first 2 weeks
Non-weight-bearing in a backslab for the first 2 weeks
Daily blood-thinning injections (anticoagulation) for the period of reduced mobility for 6 weeks
2-week clinic review: wound check, removal of sutures, and transition into full fibreglass plaster; weight-bear with crutches
4-week review: change to boot, continue with crutches; start gentle ankle range-of-movement exercises out of the boot
6-week clinic review: boot weaning begins, transition into supportive footwear, formal physiotherapy started

Mid-term Phase (6 weeks – 4 months)

Gradual weaning out of the boot into supportive trainers, typically by 8 weeks
Structured physiotherapy focusing on range of movement, peroneal strengthening, balance and proprioception, and gait re-education
Most patients return to driving once out of the boot and able to perform an emergency stop safely
Return to desk-based work is typical between 2–4 weeks; manual or standing roles usually require longer
Return to straight-line running typically permitted from 3 months
Progression onto agility, cutting and sport-specific drills with a sports physiotherapist

Long-term Phase (4 months and beyond)

Return to pivoting and contact sport typically between 4 and 6 months, dependent on functional testing and surgeon clearance
Continued use of a lace-up ankle brace during sport for the first season is often recommended
6-month clinic review with assessment of function, strength and confidence
Most patients reach their final functional outcome between 9 and 12 months after surgery

Condition-specific rehabilitation protocol: Please refer to the dedicated SFAS / Mr Welck post-operative rehabilitation protocol for lateral ankle ligament repair, which sets out the week-by-week milestones for range of movement, strengthening, balance, return to running and return to sport. Your physiotherapist will be sent a copy of this protocol following surgery.

What Are the Risks?

Lateral ankle ligament repair is a highly successful operation, but as with any surgery there are risks. Procedure-specific risks include:

Recurrent instability — a small proportion of patients continue to feel some instability, particularly with high-demand pivoting sport; revision surgery is occasionally required.
Nerve injury — particularly to the superficial peroneal and sural nerves, which run close to the surgical field — this can leave a small patch of altered sensation, numbness or tingling on the outer side or top of the foot.
Wound healing problems — the skin on the outer side of the ankle is thin; smoking, diabetes and steroid use significantly increase the risk.
Infection — superficial wound infection is uncommon and usually responds to antibiotics; deep infection is rare but may require further surgery.
Stiffness — some loss of inversion (turning the foot inwards) is expected, and is in fact part of the protective effect of the repair.
Ongoing pain — particularly if there is associated cartilage damage, peroneal tendon pathology or impingement that has not fully resolved.
Suture-anchor or internal-brace irritation — very occasionally, the small implants used to anchor the repair can cause prominence or local discomfort and may require removal.
Re-injury — a fresh significant sprain can damage the repair, particularly in the first 6–12 months; a lace-up brace during sport is recommended during this period.

General risks of any foot and ankle surgery — including bleeding, blood clots (DVT/PE), complex regional pain syndrome, scar sensitivity and anaesthetic risks — are explained in more detail in our patient leaflets: Forefoot Surgery Risks (PDF) or Hindfoot Surgery Risks (PDF).

Frequently Asked Questions

How soon can I walk normally after lateral ankle ligament repair?

Most patients walk comfortably in supportive trainers between 6 and 8 weeks after surgery, with continued improvement in strength, balance and confidence over the following months.

When can I drive after lateral ankle ligament repair?

Most patients can drive 6–8 weeks after surgery, once out of the aircast boot and able to perform an emergency stop safely. You must inform your motor insurer.

When can I return to running and sport?

Straight-line running typically begins around 3 months after surgery, with return to pivoting, contact and cutting sport between 4 and 6 months, guided by functional testing. As a foot and ankle surgeon with a specialist interest in sports injuries, Mr Welck will tailor your return-to-sport plan to your specific goals.

Do I really need surgery, or will physiotherapy alone be enough?

Physiotherapy is the first-line treatment for ankle instability and is successful for many patients. Surgery is generally reserved for patients who continue to give way, re-sprain or feel unable to return to sport despite a structured rehabilitation programme of at least 3 months.

What is the difference between a Broström repair and an internal brace?

A modified Broström procedure tightens and reattaches your own ligaments. An internal brace is a strong synthetic tape used to reinforce the repair where extra protection is needed — for example, in elite athletes, patients with very lax ligaments, or revision cases. Mr Welck will recommend the most appropriate technique for your situation.

Will the repair last?

Lateral ankle ligament repair has excellent long-term outcomes, with 85–95% of patients reporting good-to-excellent results and most returning to their previous level of sport. The risk of significant re-tear is low, particularly when a brace is worn during sport in the first season.

Will I have a noticeable scar?

The incision is small and curved, sited along natural skin lines on the outer side of the ankle. Most patients are left with a fine, well-healed scar.

Why choose Mr Matthew Welck as your foot and ankle surgeon in London?

Mr Welck is a Consultant Orthopaedic Foot and Ankle Surgeon at the RNOH Stanmore — the UK’s largest specialist orthopaedic hospital — and Honorary Associate Clinical Professor at UCL. His secondary referral practice covers lateral ankle ligament repair, sports injuries, total ankle replacement, ankle arthritis and complex hindfoot reconstruction, with patients referred from across North London, Central London, Hertfordshire and the wider UK. He has published more than 50 peer-reviewed papers on foot and ankle surgery and works as part of the Stanmore Foot & Ankle Specialists group.

Book a Consultation

If you are looking for an expert foot and ankle surgeon in London or North London for lateral ankle ligament repair, chronic ankle instability or sports-related ankle injuries, Mr Welck offers comprehensive assessment with same-visit imaging where required.

To arrange a consultation with Mr Matthew Welck:

Telephone: 07547 395 270
Online booking: matthewwelck.com/appointments
NHS referrals: through your GP to Mr Welck at RNOH Stanmore

This information is provided for general patient education and does not replace individual medical advice. Please discuss your specific case with Mr Welck or another qualified Consultant Foot & Ankle Surgeon.

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