Ankle ligament reconstruction (Lateral ankle ligament repair or reconstruction)

What is ankle ligament reconstruction?

The ligaments on the outside of the ankle are strong bands that stop it rolling over. After repeated sprains, these ligaments can become stretched or torn, so the ankle feels unstable and keeps 'giving way', especially on uneven ground. This is called chronic lateral ankle instability.

Ankle ligament surgery aims to make the ankle stable again. The most common operation is a repair (often called a modified Brostrom procedure), where the surgeon tightens and reattaches your own stretched ligaments. Where the ligaments are too damaged to repair, a reconstruction uses a strip of tendon (a graft) to rebuild them.

Surgery is usually only considered after a proper course of physiotherapy, bracing and strengthening has been tried, because many unstable ankles improve with rehabilitation alone. It is mainly aimed at instability — the feeling of the ankle giving way — rather than at pain from arthritis or other causes, which need different treatment.

It is important to be realistic: surgery can greatly improve stability, but it does not make the ankle 'new', and some people do not get fully back to their previous level of sport.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your surgery

• See a foot and ankle surgeon, who will examine your ankle for looseness and may arrange X-rays or an MRI scan.
• Be ready to show what physiotherapy, bracing and strengthening you have already tried, as surgery usually follows these.
• Discuss whether your problem is truly instability (giving way) or pain, as the operation targets instability.
• Tell the team about diabetes, smoking or any condition affecting healing and balance.
• Plan for being in a boot or cast and on crutches: arrange transport, time off work and help at home.
• Set up your home so you can manage without putting full weight through the ankle at first.
• Discuss blood-clot prevention, as reduced mobility in a boot raises the risk of a clot.

What happens

The operation is usually a day case under a general anaesthetic or a spinal/regional block, often with local anaesthetic for pain relief.

For a Brostrom-type repair, the surgeon makes a curved cut over the outer ankle, finds the stretched ligaments and tightens and reattaches them, sometimes using small anchors in the bone or a supporting tape. For a reconstruction, a strip of tendon graft is passed through small tunnels in the bone to rebuild the ligament.

The ankle is then put into a cast or boot to protect the repair. The operation usually takes under an hour, and most people go home the same day with crutches and instructions on weight-bearing.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The most relevant specific risks are nerve irritation around the outer ankle (which can leave numbness) and the chance that some instability returns. Some studies suggest keyhole repairs with anchors carry a higher complication rate, including nerve problems, than open surgery. Ask your surgeon which technique they use and why, and how they protect the nearby nerves.

Published figures to discuss

Reported complication rates vary with the technique used (open Brostrom-type repair versus arthroscopic repair with anchors), the rehabilitation protocol and the patient. The figures below are cautious and drawn from systematic reviews; they are general guidance, not a personal prediction. Nerve irritation and some recurrence of instability are the most consistently reported issues.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery takes months and depends heavily on physiotherapy. Expect several weeks in a boot or cast protecting the repair, followed by a structured programme to rebuild strength, movement and balance.

• Swelling and bruising around the ankle and foot in the early weeks
• Stiffness, particularly turning the sole inward, that eases with physiotherapy
• A weaker, less confident ankle at first that strengthens over months
• Some numbness around the scar that often settles

Aftercare

• Keep the leg elevated in the early days to reduce swelling.
• Keep the cast or boot dry and wear it exactly as instructed.
• Take blood-clot prevention as advised and watch for calf pain, swelling or breathlessness.
• Use crutches and only put weight through the ankle as your team allows.
• Attend physiotherapy and do your balance and strengthening exercises, which are central to recovery.
• Do not return to driving until you can safely control a vehicle and your team confirms it is allowed.
• Keep follow-up appointments so healing and stability are checked.

• Crutches ready at home
• A plan for getting home without driving
• Time off work arranged (longer for jobs on your feet)
• Help at home for the first weeks
• A waterproof cover for showering with the boot or cast
• The clinic's contact number saved for wound or clot concerns

Scars and how they heal

Open repair leaves a curved scar over the outer ankle, usually a few centimetres long; keyhole techniques use smaller cuts. Scars usually fade over months but can occasionally be thickened or sensitive, and a small patch of numbness near the scar is common. Protect the area and report any redness, gaping or discharge.

⚠ Get urgent help if…

• Calf pain, swelling, warmth or redness, or sudden breathlessness or chest pain — possible blood clot, seek urgent help
• Spreading redness, heat, increasing pain or discharge from the wound — possible infection
• The wound opening up or the edges separating
• Severe or worsening pain not controlled by your usual painkillers
• New numbness, severe burning pain or weakness in the foot
• A high temperature or feeling generally unwell after surgery

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result means a stable ankle that no longer gives way, letting you walk on uneven ground and return to activity with more confidence. Many people are satisfied after a Brostrom-type repair. Even so, surgery does not restore a 'normal' ankle, some stiffness or minor numbness can remain, and not everyone returns to their previous level of sport.

Results depend on the quality of the original ligament tissue, the technique used and how well rehabilitation is completed. Where instability returns, a reconstruction with a tendon graft may be considered.

For most people, a successful repair gives lasting stability. However, ligaments can stretch again over time, particularly with repeated injury or in people with naturally loose joints, and instability can recur. Continuing balance and strengthening work helps protect the ankle. Long-standing instability and repeated sprains can contribute to ankle arthritis over many years, which is a separate problem.

Combining with other procedures

Ankle ligament surgery is sometimes combined with keyhole inspection of the joint (arthroscopy) to treat other problems found inside the ankle, such as loose fragments or cartilage damage. Your surgeon will explain if anything extra is planned, as this can affect recovery.

Follow-up & long-term care

You will usually be reviewed to check the wound and remove stitches, then at intervals as you progress out of the boot and through physiotherapy. Report wound problems, calf pain or returning instability promptly.

• Keep up balance (proprioception) and strengthening exercises after formal physiotherapy ends.
• Consider a brace or supportive footwear for high-risk sport, as advised.
• Build training gradually and avoid uneven ground until your ankle is reliably strong.

Revision and secondary surgery reality

• If instability returns, revision surgery or a tendon-graft reconstruction may be needed.
• A repair using your own tissue can stretch again over time, particularly with repeated injury.
• Nerve irritation may settle but occasionally needs further management.
• Final stability and function are judged over many months.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• A clear, staged boot and physiotherapy plan focused on strength and balance.
• Active blood-clot prevention and clear advice on clot warning signs.
• Prompt review of any wound concern or new nerve symptoms.
• Honest discussion about expected stability, return to sport and the chance of recurrence.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The surgeon's fee and whether a repair or a graft reconstruction is needed
• Anaesthetic fee and type (general, spinal/regional or local)
• Theatre and facility fees
• Imaging such as X-ray or MRI before surgery
• Any implants used, such as suture anchors or a synthetic tape
• Boot or cast, crutches and clot-prevention medicines
• The course of physiotherapy and any follow-up appointments

• The operating surgeon's fee
• Anaesthetist's fee and the type of anaesthetic
• Theatre and facility fees, and any overnight stay
• Cost of any anchors, tape or graft used
• Boot/cast, crutches and blood-clot prevention
• How many physiotherapy sessions are included and the cost of further ones
• What happens, and who pays, if instability returns or a complication occurs

On the NHS? Ankle ligament reconstruction is available on the NHS for chronic instability that has not improved with physiotherapy and bracing; private care is sometimes chosen for speed or choice of surgeon.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Is my problem truly instability, or is pain the main issue?
• Have I had enough physiotherapy before considering surgery?
• Will you repair my own ligaments or reconstruct them with a graft, and why?
• Open or keyhole technique — which do you recommend and how do you protect the nerves?
• What is my personal chance of the instability coming back?
• What will my boot and physiotherapy timeline look like?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for ankle ligament reconstruction

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: BOFAS (British Orthopaedic Foot & Ankle Society) — UK specialist-society patient guidance on ankle instability (accessed 2026); no dedicated NICE/UK national guideline covers this specific operation Complication rates: arthroscopic vs Brostrom-Gould repair — systematic review (PMC) Early vs delayed mobilisation after lateral ankle ligament repair — review (PMC) Return to play after modified Brostrom reconstruction (PMC) Modified Brostrom with suture-tape augmentation for chronic instability (PMC) NHS — Sprains and strains (national UK guidance on ankle sprains and first-line non-surgical care; reviewed Apr 2024)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.