Hamilton et al. report outcomes of the Gould modification of the Brostrom anatomic repair for lateral ankle instability in 28 ankles. 54% of patients were professional ballet dancers — a uniquely high-demand population requiring full plantarflexion, dorsiflexion, and intact peroneal function. The study asks whether this technique can restore stability without sacrificing the range of motion these athletes require.
A high-demand athlete with Grade III lateral ankle instability (positive drawer, talar tilt >18°) who has failed a structured peroneal strengthening program is a surgical candidate — and the Brostrom-Gould is the right operation.
The extensor retinaculum step is not optional. It limits inversion, reinforces the primary repair, and addresses the subtalar component that ligament repair alone does not correct. Skipping it leaves a gap in the reconstruction.
In ballet dancers specifically, Grade III instability is loose beyond what peroneal strength can compensate regardless of how fit the athlete is. That is the hard threshold for surgery in this population.
Do not let a negative or borderline stress radiograph talk you out of operating on a clinically unstable ankle. This paper documented poor correlation between imaging and function. The clinical exam drives the decision.
Karlsson et al. (180 cases, 6-year follow-up) reported 89% good-to-excellent results with the original Brostrom procedure without Gould's modification. Hamilton's series, including the most demanding athletic population imaginable, matched or exceeded that rate with zero failures. Supporting the Gould modification as the preferred construct.
Hamilton et al. report outcomes of the Gould modification of the Brostrom anatomic repair for lateral ankle instability in 28 ankles. 54% of patients were professional ballet dancers — a uniquely high-demand population requiring full plantarflexion, dorsiflexion, and intact peroneal function. The study asks whether this technique can restore stability without sacrificing the range of motion these athletes require.
A high-demand athlete with Grade III lateral ankle instability (positive drawer, talar tilt >18°) who has failed a structured peroneal strengthening program is a surgical candidate — and the Brostrom-Gould is the right operation.
The extensor retinaculum step is not optional. It limits inversion, reinforces the primary repair, and addresses the subtalar component that ligament repair alone does not correct. Skipping it leaves a gap in the reconstruction.
In ballet dancers specifically, Grade III instability is loose beyond what peroneal strength can compensate regardless of how fit the athlete is. That is the hard threshold for surgery in this population.
Do not let a negative or borderline stress radiograph talk you out of operating on a clinically unstable ankle. This paper documented poor correlation between imaging and function. The clinical exam drives the decision.
Karlsson et al. (180 cases, 6-year follow-up) reported 89% good-to-excellent results with the original Brostrom procedure without Gould's modification. Hamilton's series, including the most demanding athletic population imaginable, matched or exceeded that rate with zero failures. Supporting the Gould modification as the preferred construct.