What is the modification in the Modified Broström-Gould procedure?

• A. Suture anchors in the fibula
• B. Tendon transfer from peroneus brevis
• C. Use of the extensor retinaculum to reinforce the repair
• D. Graft from fascia lata

Answer: (C)

This modification adds reinforcement of the repaired lateral ligaments by using a flap of the extensor retinaculum. After the ATFL (and often the CFL) is reanchored, a strip of the extensor retinaculum is mobilized and laid over the repair, then fixed to the fibula and sometimes to the talus or calcaneus to create an extra supportive layer. This autologous tissue reinforcement acts like a protective sling, increasing stability against inversion and anterior talar migration and reducing the chance of recurrent laxity.

Other approaches described in the options involve different augmentation strategies (such as tendon transfer or distant grafts) or rely on the repair itself with suture anchors, but the distinctive feature of the Modified Broström-Gould is this reinforcement with the extensor retinaculum.