Important Information
Rehabilitation following lateral ankle ligament reconstruction varies depending on associated procedures, including peroneal tendon surgery, osteotomies, cartilage procedures, or use of augmentation (e.g., suture-tape/internal brace). This protocol outlines a general guideline. Progression may be modified based on intraoperative findings, individual healing response, and surgeon discretion. Please contact our office with any questions regarding your specific rehabilitation plan.

Immobilization / Weight Bearing

• Non-weight bearing
   
• Short leg splint at all times
   

Precautions

• No ankle inversion
   
• Protect surgical repair
   

Goals

• Minimize swelling
   
• Protect ligament reconstruction
   
• Promote wound and skin healing
   

Recommended Care

• Strict elevation (foot above heart level)
   
• Ice and swelling control modalities as tolerated
   
• Gentle toe motion
   

Immobilization / Weight Bearing

• Transition from splint to CAM walking boot at 2 weeks
   
• Begin progressive weight bearing as tolerated in the boot
   
• Boot worn for ambulation and sleeping unless otherwise instructed
   

Precautions

• No inversion stretching
   
• Avoid unstable surfaces (no wobble board or uneven terrain)
   

Goals

• Restore sagittal plane ankle motion
   
• Maintain stability of the repair
   
• Improve neuromuscular control
   

Physical Therapy Focus

• Edema and scar management
   
• Controlled ankle motion
   
• Gait training
   

Range of Motion

• Plantarflexion and dorsiflexion only
   
• Target by end of phase:
   
  • ≥10° dorsiflexion
     
  • ~30° plantarflexion
     

Exercises

• Stationary cycling
   
• Active and active-assisted ankle dorsiflexion/plantarflexion
   
• Isometric peroneal activation
   
• Multi-angle isometrics within allowed ROM
   
• Seated rocker board (sagittal plane only)
   
• Rhythmic stabilization (DF/PF)
   
• Upper body strengthening as tolerated
   

Bracing

• Discontinue CAM boot
   
• Transition to ankle brace:
   
  • ASO ankle brace or
     
  • Tayco ankle brace, based on comfort and activity level
     

Precautions

• Gradual reintroduction of inversion after 6 weeks, under PT guidance
   

Goals

• Restore full ankle range of motion
   
• Improve strength, balance, and neuromuscular control
   
• Prepare for higher-level functional activity
   

Physical Therapy Focus

• Full active ankle ROM in all planes
   
• Progressive strengthening
   
• Balance and proprioceptive training
   

Exercises

• Resistance band ankle strengthening
   
• Double- and single-limb calf raises
   
• Static and dynamic balance training
   
• BAPS board (levels 1–2)
   
• Step-ups and functional closed-chain exercises
   
• Treadmill walking
   
• Stationary cycling
   
• Wall squats and lower extremity strengthening
   

Bracing

• Continue ankle brace for higher-risk activities and sports
   
• Brace use is recommended for 3–6 months, or for the first season after return to sport
   

Goals

• Restore sport-specific strength, agility, and confidence
   
• Safe and durable return to athletic participation
   

Physical Therapy Focus

• Plyometrics
   
• Agility and cutting drills
   
• Sport-specific training
   

Exercises

• Interval running progression
   
• Single- and double-limb plyometrics
   
• Agility ladders and shuttle runs
   
• Box jumps and hopping drills
   
• Sport-specific movement patterns
   

Return to sport is typically allowed at the earliest around 12 weeks, but is criteria-based, not time-based. Clearance requires:

• Clearance by physical therapy and surgeon
   
• Minimal to no swelling following activity
   
• Full or near-symmetric ankle range of motion
   
• Functional strength appropriate for sport demands
   
• Good dynamic balance and neuromuscular control
   
• Ability to perform 10 single-leg hops on the operative side
   
  • Without pain
     
  • Without instability
     
  • Without compensatory movement patterns
     

Note:
While some patients may meet criteria near 12 weeks, full unrestricted competitive play often occurs closer to 3–5 months, particularly for cutting and pivoting sports. Associated cartilage procedures or osteotomies may delay return further.

• Cartilage procedures (OCD/microfracture): Return to sport may be delayed
   
• Peroneal tendon repair or osteotomy: Progression may be slower
   
• Augmented repairs (e.g., suture-tape/internal brace): May allow accelerated progression at surgeon discretion
   

1. Reider B, et al. Orthopaedic Rehabilitation of the Athlete: Getting Back in the Game. Elsevier/Saunders, Philadelphia, 2015.
    
2. Kerkhoffs GMMJ, et al. Surgical treatment for chronic lateral ankle instability: a systematic review. Am J Sports Med. 2012.
    
3. Broström L. Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir Scand. 1966.
    
4. Vora AM, et al. Clinical outcomes following Broström repair with suture tape augmentation. Foot Ankle Int.
    
5. Mass General Brigham Sports Medicine. Rehabilitation Protocol for Broström Lateral Ankle Ligament Repair.
    
6. Ohio State University Wexner Medical Center. Broström Procedure Clinical Practice Guideline.