Internal Bracing for reconstruction of the anterior talofibular ligament (ATFL)

This procedure is indicated for chronic unstable ankle.

Some people have ankle sprains now and then. When the ankle sprains a ligament on the outer site tears and this is painful and most frequently it is the anterior talofibulare ligament that tears (ATFL). The ankle will be weak and there will be a period ranging from days to month to recover - keeping you out from sporting activity.

For some the ankle continues to be unstable and this is naturally very bothersome. Sometimes it is just recurrent sprains, and in other cases the ankle also feels unstable and wobbly, and in those cases stabilising surgery is indicated. A relatively new surgical technique has become widespread very fast, based on its simplicity, the lack of postoperative bracing and the fast recovery and good results. The surgery is based on the traditional Broström operation where the sprain ligament is tightened, but instead of placing the ankle in a brace an internal bracing is used - meaning it is tightened and reinforced by a synthetic ligament.  

Sometimes when the ankle sprains, the joint cartilage can get damaged. The symptoms for this is continuous pain​ and swelling and eventually locking. If this is the situation it will be a good idea to have an arthroscopy in combination with the ankle-stabilising surgery. With the arthroscope the damaged cartilage can be identified and loose cartilage can be removed and eventually stimulation for repair of the lesion can be done (Microfracture also called Steadmann procedure). 

If your ankle is unstable it is very important to prevent further sprains by undergoing a physiotherapy-guided rehabilitation program. Afterwards you need to continue yourself with balancing exercises using a tilt or wobble board.  

This link is to a video animation of Internal Bracing of the ankle after a Brostöm repair

Professor Gordon Mackay has developed and popularised this procedure, especially in the ankle. Professor Adrian Wilson has also pioneered the use of internal braces in different knee ligaments with the synthetic graft (Fibertape, Arthrex).