 
 
Rehabilitation Protocol for Brostrom Lateral Ankle Ligament 
Repair 
  
This protocol is intended to guide clinicians through the post-operative course for Brostrom repair. This protocol is time 
based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs of the 
individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes 
contained within this guideline may vary based on surgeon’s preference, additional procedures performed, and/or 
complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult with 
the referring surgeon. 
  
The interventions included within this protocol are not intended to be an inclusive list of exercises. Therapeutic 
interventions should be included and modified based on the progress of the patient and under the discretion of the 
clinician.  
  
Considerations for the Post-operative Brostrom Repair 
Many different factors influence the post-operative Brostrom rehabilitation outcomes. Consider taking a more 
conservative approach to range of motion, weight bearing, and rehab progression with tendon augmentation or 
peroneal tendon repair, revision, patients with hyper-ligamentous laxity, and co-morbidities such as obesity and 
advanced age. It is recommended that clinicians collaborate closely with the referring physician regarding intra-
operative findings and satisfaction with the strength of the repair. 
 
PHASE I: IMMEDIATE POST-OP (0-2 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect repair 
• Edema control/reduction 
• Minimize muscle atrophy in proximal musculature 
Weight Bearing 
• Non-weight bearing with crutches 
Interventions 
Range of motion/Mobility 
• Supine passive hamstring stretch 
• Avoid A/PROM into inversion 
• Avoid A/PROM into plantarflexion 
 
Strengthening 
• Quad sets 
• Straight leg raises 
• Hip abduction 
• Prone hamstring curls 
Criteria to 
Progress 
• Decreased pain and edema 
• Independent with transfers with appropriate weight bearing precaution 
 
PHASE II: INTERMEDIATE POST-OP (3-6 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Continue to protect repair 
• Edema and pain control 
• Progress weight bearing using appropriate assistive device 
• Gradually restore ankle dorsiflexion, eversion and plantar flexion 
Weight Bearing 
• Weight bearing as tolerated in boot 
Additional 
Interventions 
Range of motion/Mobility 
• PROM/AAROM/AROM: ankle dorsiflexion, plantar flexion, eversion 
 
 
*Continue with 
Phase I 
interventions 
- Avoid ankle inversion 
• Gentle long-sitting gastroc stretch 
 
Cardio 
• Upper body ergometer 
 
Strengthening 
• Submax ankle isometrics all direction except inversion 
• Lumbopelvic strengthening: sidelying clamshells, plank 
 
Balance/proprioception 
• Joint position re-training 
Criteria to 
Progress 
• Decreased pain and edema 
• Full ROM ankle dorsiflexion, plantar flexion, eversion (inversion to neutral) 
• Independent with home exercise program (HEP) 
 
PHASE III: LATE POST-OP (7-8 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Continue to protect repair 
• Normalize gait pattern 
• Restore full ROM 
• Begin controlled ankle strengthening 
Weight Bearing 
• Weight bearing as tolerated in shoe with active ankle brace 
Additional 
Interventions 
*Continue with 
Phase I-II 
Interventions  
Range of motion/Mobility 
• Gentle stretching of proximal lower extremity muscles: prone quad stretch, standing quad 
stretch, kneeling hip flexor stretch 
• Gentle standing gastroc stretch and soleus stretch 
• Ankle/foot mobilizations adhering to identified precautions (avoid stress to CFL and ATFL) 
 
Cardio 
• Stationary bike, flutter kick swimming, pool jogging if patient has access to pool and fully healed 
incision 
 
Strengthening 
• 4 way ankle theraband 
• Calf raises 
• Seated calf machine 
• Lumbopelvic strength progressions: bridges on physioball, bridge on physioball with hamstring 
curl, bridge on physioball with alternating march 
• Supplemental gym strengthening: leg press, knee extension machine, hip abductor and adductor 
machine 
 
Balance/proprioception 
• Double limb standing on uneven surface (wobble/rocker board) 
• Single limb balance with progression to uneven surface including perturbation training 
Criteria to 
Progress 
• Normalized gait pattern without assistive device 
• Ankle ROM equal to uninvolved 
• Symmetrical joint position sense (within 5 degree error) 
 
PHASE IV: TRANSITIONAL (9-12 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Maintain full ankle ROM 
• Progress ankle and lower extremity strengthening 
• Avoid post exercise pain/swelling 
• Normalize function movements 
 
 
Additional 
Interventions 
*Continue with 
Phase I-III 
interventions 
Strengthening 
• Single leg calf raises 
• Squats 
• Dead lifts 
• Resisted stepping 
 
Balance/proprioception 
• Y-balance/Star balance 
• Single leg balance with ball toss 
• Step ups with single leg holds 
Criteria to 
Progress 
• Able to perform 25 single leg heel raises. 
• 90 percent performance with Y-balance / Star balance test on involved LE compared to 
uninvolved side. 
• No pain or swelling after exercises. 
 
PHASE V: EARLY RETURN TO SPORT (3-4 MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
• Safely progress strengthening 
• Promote proper movement patterns 
• Avoid post exercise pain/swelling 
Additional 
Interventions 
*Continue with 
Phase II-IV 
interventions 
Cardio 
• Elliptical, stair climber 
 
Range of Motion/Mobility 
• Standing gastroc stretch and standing soleus stretch 
 
Strengthening 
• Squat to chair 
• Hip hike 
• Lateral lunges 
• Single leg progression: partial weight bearing single leg press, slide board lunges, step 
up/downs progression, single leg wall slides 
Criteria to 
Progress 
• No swelling/pain after exercise 
• No swelling/pain with 30 minutes of fast paced walking 
• 90 percent performance single leg hop test for distance and triple hop for distance 
• Cumberland Ankle Instability Tool (CAIT) of FAAM 
 
PHASE VI: UNRESTRICTED RETURN TO SPORT (5-6+ MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
• Continue strengthening and proprioceptive exercises 
• Safely initiate sport specific training program 
• Symmetrical performance with sport specific drills 
• Safe progression into full sport 
Additional 
Interventions 
*Continue with 
Phase II-V 
interventions 
• Interval running program 
• Return to Running Program 
• Agility and Plyometric Program 
Criteria to 
Progress 
• Last stage, no additional criteria 
   Revised 12/2021 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
 
References: 
 
 
 
1. 
Caffrey E, Docherty CI, et al. The Ability of 4 Single-Limb Hopping Tests to Detect Functional Performance Deficits in Individuals With Functional 
Ankle Instability. JOSPT. 2009; 39:799-806 
 
2. 
Garrison JC, Bothwell JM, Wolf G, Aryal S, Thigpen CA. Y Balance Test Anterior Reach Symmetry at Three Months is Related to Single Leg Functional 
Performance at Time of Return to Sports Following Anterior Cruciate Ligament Reconstruction. Int J Sports Phys Ther. 2015;10(5):602-11. 
 
3. 
Lee K, Jegal H, et al. Return to Play After Modified Brostrom Operation for Chronic Ankle Instability in Elite Athletes. Clinics in Orthopedic Surgery. 
2019; 11:126-130. 
 
4. 
Mandelbaum BR, Silvers HJ, Watanabe DS, et al. Effectiveness of Neuromuscular and Proprioceptive Training Program in Preventing Anterior 
Cruciate Ligament Injuries in Female Athletes: 2 year follow-up. Am J Sports Med. 2005; 33:1003-1010. 
 
5. 
Miyamoto W, Takao M, Yamada K, Matsushita T. Accelerated Versus Traditional Rehabilitation After Anterior Talofibular Ligament Reconstruction 
for Chronic Lateral Instability of the Ankle in Athletes. Am J Sports Med. 2014;42(6):1441-7. 
 
6. 
Pearce CJ, Tourne Y, et al. Rehabilitation After Anatomical Ankle Ligament Repair or Reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016; 
24:1130-1139 
 
 
 
 
 
