The typical sensations associated with ankle instability include repetitive twisting or spraining, weakness, apprehension or fear of twisting, and frequently is associated with pain from the damage that has resulted from such injuries.
Ankle Ligament Reconstruction: What is it?
With twisting injuries of the ankle, the ligaments may be torn and may not heal sufficiently to provide adequate stability in the ankle.
When bracing or taping and physical therapy have not been successful, the ankle ligaments may be reconstructed to help prevent further twisting injuries and instability. In the setting of chronic ankle instability, repetitive twisting injuries may lead to other associated injuries, including Ankle Cartilage (Osteochondral) Defect, ankle impingement:, loose bodies, and peroneal tendon tears. Because these associated injuries have been reported to be as high as 93% (Komenda and Ferkel), we recommend ankle arthroscopy at the time of lateral ligament reconstruction.
There are several procedures to reconstruct the ankle ligaments. Anatomic repairs which reconstruct the normal anatomy of the ligaments are recommended. The most common operation is called the modified Brostrum procedure, in which an incision is made around the lateral ankle bone and theATFL and CFL are re-attached and tightened. Very small anchors may be drilled into the bone as needed for additional strength. The retinaculum also is incorporated into the repair for additional repair strength.
Other operations are used less frequently but may be considered depending on other associated factors including generalized laxity, body weight, level of activity, and previous surgery. These factors are considered on a case by case basis to optimize surgical outcomes. One of the peroneal tendons can be incorporated into the repair or allograft (cadaver) tendons also may be used in these circumstances.
Following surgery, you will need to use crutches for about two weeks.
The boot is worn for 4-6 weeks, and then an ankle stirrup brace in a shoe is worn for an additional 4 more weeks.
Running, cutting and ball and racket sports are not permitted for 3- 4 months after the surgery.
Post Operative Course:
- The foot is wrapped in a bulky plaster splint
- Ice, elevate, and take pain medication
- Expect numbness in the foot for 12-24 hours because of the anesthesia block
- Bloody drainage through the splint is expected
- Do not remove the splint but you may add additional ACE wrap bandage
- Dressing changed, sutures/staples removed
- Boot is applied to the foot with a lateral heel wedge
- Weight-bearing in the boot as tolerated
- The boot may be removed for showering. There is no bathing until the wound is completely healed
- Start ankle up and down motions (dorsiflexion and plantarflexion only) while avoiding heel side to side motions
- Start physical therapy
- Air cast stirrup is worn for support for one month
- Gradual increase in exercise started at 10 weeks after surgery
If you have any questions about the information on this page about Ankle Stability, please contact Dr. Dominic Carreira.