Ankle ligament (reconstruction) surgery
Ankle ligament (reconstruction) surgery
Ankle ligament (reconstruction) surgery
Ankle ligament (reconstruction) surgery
What is ankle ligament reconstruction surgery?
If you’ve sprained your ankle badly and it’s not recovering, or if you keep ‘going over’ on your ankle, you may have ankle instability. Often patients with ankle instability will complain of an ankle that swells after sports, is painful, or feels like they can’t rely on it.
Physiotherapy is the first line treatment for ankle instability, and you should do this for at least 6 to 12 weeks.
Ankle instability usually occurs because the ligaments on the outside of the ankle joint (called the anterior talofibular, calcaneofibular and posterior talofibular ligaments), are either torn or very stretched.
An ankle sprain that occurred many years ago can over the long-term lead to instability, because each time you go over on the ankle, you may further damage the ligaments.
Sometimes, the articular cartilage within the ankle can also be damaged and the instability can put excess stress on the peroneal tendons that also support the lateral side of the ankle.
Studies have shown that ankle instability is a risk factor for developing ankle arthritis.
How is ankle instability diagnosed?
When you come to clinic, I’ll want to listen carefully to the symptoms you’ve been experiencing, how your ankle is behaving, and how that is impacting on your everyday life. I’ll also want to know what treatments you’ve tried so far (such as physiotherapy, injection treatments and bracing). I’ll watch how you move, walk and balance, and I’ll carefully examine your ankle for signs of swelling, tenderness, it’s range of movement, and whether you have clinical signs of instability or tendon damage.
I may then recommend that you undergo MRI imaging to give further information about ligament or joint surface damage.
What happens during lateral ankle ligament reconstruction surgery?
Ankle ligament reconstruction (sometimes known as the modified Broström-Gould procedure) is a day-case procedure. You’ll come into hospital, have a general anaesthetic, and you’ll go home on the same day. The first stage is to carry out an ankle arthroscopy as part of the procedure, to clear away any scarring, inflamed soft tissues (aka synovitis) or internal debris and to check the joint surfaces are ok. Cartilage damage, if present, can be treated at the same time.
The surgery involves a small incision around the lateral (outside) side of the ankle, and the torn ligaments are repaired and anchored in place onto the fibula bone. The mend is made stronger by reinforcing the ligaments by pulling up the back edge of the retinaculum (a gristle band) over the sutured ligaments, and the retinaculum is also fastened to the fibular bone. In a small proportion of patients, further reinforcement with an ‘internal brace’ may be required. If there is foot malalignment e.g. a cavovarus foot alignment (heels tilting inwards with a high arch), surgery to correct this may be required.
Many kids and adolescents experience persistent pain in the lateral (outer) side of their ankle, after a sprain, because they have had a small avulsion fracture of the tip of the lateral malleolus. This means that instead of the ligament tearing, it pulls off a tiny piece of bone instead. This can cause impingement and pain in the side of the ankle, which can also inhibit normal balance and stability of the ankle. This is a common problem, and I regularly carry out surgery to remove these bony fragments, and reattach lateral ligaments to where they belong.
What’s it like to recover from ankle instability surgery?
After the surgery you’ll spend a short while in recovery, and then you’ll return to the ward. You’ll have a plaster cast on your ankle, and you will be able to weight bear on it. Whenever you can, try to put your foot up, above the level of your heart, to help reduce swelling.
You’ll be given painkillers when you leave hospital, and most patients are quite comfortable.
We will meet again in clinic after three weeks, and your cast and dressings will be removed. You’ll be given an ankle brace to wear, and you’ll start intense physiotherapy to strengthen and mobilise. You’ll wean off the brace depending on how you progress with your physio.
When can I drive after ankle ligament surgery?
To drive safely, you need to be out of the cast and able to do an emergency stop, and for most people, it’s around six weeks before they can drive again. If you drive an automatic car, and you’ve had surgery on your left ankle, you can drive when you feel comfortable sitting in a driving position.
When can I return to work after ankle ligament surgery?
I recommend that you take two weeks off work if you have desk-based job (because it’s important to elevate your leg), but if you have a role where you’re on your feet all day, or are doing manual labour, you may need to take 6 weeks off.
You may be able to return to low impact sports at around 3 months, but it takes a good 6 months to fully recover from the surgery and return to high-impact activities.
How successful is ankle ligament reconstruction surgery?
Studies have shown that more than 90% of people report having an excellent outcome after this surgery. Thankfully most reconstructions stand the test of time, and it’s very unusual for them to fail. Sometimes the ankle may feel a little stiff post-surgery, but it rarely causes an issue for patients. It’s very important to fully engage with the physiotherapy after the surgery, to prevent a recurrence of the injury.
