Brostrum-Gould Lateral Ligament Reconstruction - Rehabilitation Protocol:
Phase 1- Weeks 1-2:
Physiotherapy goals:
- Maintain independent ambulation
- Pain and oedema control
- Protection of operated leg in a short-leg non-weight-bearing cast
Interventions:
- Patient discharged from hospital in a below-knee plaster of Paris backslab
- Mobilisation with crutches, non-weight-bearing
- Encouraged to maintain limb elevation for “55 minutes in the hour”
- Attend clinic no later than 2 weeks post-op for removal of sutures
- Change to pneumatic walking boot at 2 weeks
Phase 2- Weeks 2-6:
Physiotherapy goals:
- Protection of the healing tissues
- Avoid any hindfoot inversion (healing CFL)
- Avoid any forced ankle plantarflexion (healing ATFL)
- Progressive normalization of gait
- Avoid stiffening of the ankle
- Pain and oedema control
Precautions:
- No active, passive or active-assisted inversion exercises
- No active-assisted or passive stretching into plantarflexion
- Avoid prolonged walking and standing
Interventions:
- Progressive weight-bearing in the pneumatic walker then an ankle-stirrup brace at week 4-6
- Ankle joint mobilisation adhering to the precautions above-avoid stretching the repaired CFL and ATFL
- Gastroc/soleus stretches
- Isometric exercises- resisted peroneal, tibialis anterior, tibialis posterior and gastroc/soleus activation- with ankle at neutral dorsi/plantarflexion and no inversion beyond neutral
- Pain and oedema control with ultrasound/cryotherapy/deep tissue massage
Phase 3- Weeks 6-12:
Physiotherapy goals:
- Restore full range of motion (ROM) and 5/5 power in all muscles by week 12
- Minimal pain and swelling after activity
- Normal walking on stairs and uneven surfaces with/without the ankle stirrup brace
Precautions:
- Patient can commence active inversion exercises at week 8
- To utilise the ankle brace with progression of activity
- No pylometric exercises until week 12
Interventions:
- Gait training on level and uneven surfaces
- Continue oedema control and ROM exercises
- Gastroc/soleus stretches
- At week 8 begin active inversion and continue active ROM in all planes
- Proprioceptive physiotherapy after week 8 – balance boards, single leg stance eyes open/closed, ball catching
- Strengthen foot intrinsic muscles
- Begin resisted active ROM exercises in all planes of motion from week 8-10 utilising closed and open chain exercises
- Commence heel raises and use of stair climbing/stair master/exercise bike
Phase 4- Weeks 12+:
Physiotherapy goals:
- Continue use of ankle stirrup brace during sport for up to 6 months to encourage support and proprioceptive feedback
- Patient to increase level of activity independently
Interventions:
- Increase strengthening of all muscle groups against resistance
- Commence jogging and running
- Improve endurance- rope jumping etc
- Proprioceptive drills
- Pylometrics- after warm-up exercises-bilateral jumps up to and down from a 4 inch then a 6 inch box maximum of 2 x 10 reps in any single session then progress to single leg jumps with the same protocol
- Begin sport-specific physio.- sprint/shuttle-stop, single leg hops and direction-changing