imbricated (Brostrom, 1966). Some authors advance
the shortened ligaments into the distal fibula. This
procedure is sometimes modified by advancing the
extensor retinaculum proximally (the Gould modifica-
tion) to further tighten the lateral aspects of the ankle
and subtalar joints (Gould, Seligson, and Gassman,
1980).
•Tendon transfers most commonly utilize one half of
the peroneus brevis tendon, which is divided proxi-
mally about 15 cm proximal to its insertion in the base
of the fifth metatarsal. The transferred peroneus brevis
tendon is then passed through holes in the talar neck,
distal fibula, and lateral calcaneus in order to recon-
struct the lateral ligamentous structures. In lieu of drill
holes, the transferred tendon may be sutured directly to
bone using suture anchors. A detailed discussion of all
these procedures is beyond the scope of this chapter
(Sammarco and DiRaimondo, 1988; Sammarco and
Idusuyi, 1999; Snook, Chrisman, and Wilson, 1985).
POSTOPERATIVE CARE
•Following lateral ankle ligamentous reconstructive
procedures, most postoperative regimens immobilize
the ankle in a cast for 4 weeks followed by an ortho-
sis for 4 additional weeks.
•Physical therapy is instituted at 6–8 weeks post sur-
gery with an emphasis on peroneal strengthening and
propioceptive training.
- Return to sports occurs at about 3 months postopera-
tive.
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