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. Instability of the ankle may show itself in the form of pain or repetitive twisting injuries of the ankle. With each additional sprain that a patient may experience, the ligaments of the ankle can become increasingly loose and dysfunctional. This can result in either chronic pain or repeated twisting episodes. Other associated injuries may also result, including Ankle Cartilage (Osteochondral) Defect, ankle impingement, loose bodies, and peroneal tendon tears. If the twisting episodes are repetitive or if pain persists despite time, conservative treatments such as physical therapy, bracing, medications, and activity modification, then surgery may be an option to help both in the short and long-term.
Caption for image on the right: These two ligaments of the lateral ankle are the most frequently injured in the human body. The modified Brostrom technique includes direct anatomic repair of these ligaments. 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.
There are several procedures to repair or reconstruct the ankle ligaments, many of which have been studied with clinical outcomes and biomechanical cadaveric studies of strength and stability.
Below is a description of the options:
- Brostrom Traditional Repair of Ligaments with Sutures Alone
- Brostrom Repair with aAnchors (Arthroscopic and Open with Similar Stability)
- Brostrom Repair Augmented with Suture Tape
- Allograft Reconstruction
Arthroscopic Repair of Lateral Ligaments with Suture Anchors
Open vs. Arthroscopic Reconstruction with Cadaver Grafting
Reasons to consider reconstruction over repair include generalized laxity, increased body weight, high demand level of activity, and previous surgery. These factors are considered on a case by case basis to optimize surgical outcomes. More recently, Dr. Carreira is one of the very few surgeons internationally who performs an all arthroscopic cadaver ligament reconstruction of the lateral ligaments of the ATFL and CFL. This has the added advantage of being minimally invasive, and may lead to fewer complications, less scarring, and less pain when compared with an open procedure. Dr. Carreira considers all of these factors in his evaluation of whether a particular treatment is right for you.
- Following surgery, you will need to use crutches for about two weeks.
- The boot is worn for 6 weeks, and then an ankle stirrup brace in a shoe is worn for an additional 6 weeks.
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
- First visit to the office
- Change dressings and place in a short leg cast
Elevate the leg regularly to prevent excessive swelling and wound problems
- Sutures removed
- CAM Boot is applied
- 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
- The CAM boot is weaned to a sneaker-like shoe
Air cast stirrup is worn for support for 6 weeks
Return to sport typically occurs between 6 weeks and 6 months after surgery, depending on the procedure and any associated injuries treated at the time of surgery.