What is the goal of lateral ankle ligament reconstruction (ALR)?
The goal of this surgery is to restore normal stability to the ankle. This should also fix a patient’s feeling that the ankle “gives way” and any pain that is associated with an unstable ankle.
What signs indicate surgery may be needed?
Surgery is considered when you have an unstable ankle that does not respond to nonsurgical treatment. Six months of nonsurgical treatment is often recommended before surgery. A physical examination will show that the ankle is unstable, and X-rays are sometimes used to help with the diagnosis.
When should I avoid surgery?
Your general health plays a role in any decision to have surgery. Patients with nerve or collagen diseases may not be helped by this type of surgery. Other diagnoses, including ankle joint arthritis, may require different surgeries that treat the bones and joints. Chronic pain may benefit most from nonsurgical management with a pain specialist. Surgery is not recommended for treatment of a single ankle sprain.
General Details of the Procedure
ALR is typically an outpatient surgery. It is most often done under general or regional anesthesia. Other surgeries may be performed at the same time. This commonly includes arthroscopic surgery of the ankle joint. At least one larger incision is required for the ligament reconstruction.
Several different techniques can be performed depending on the individual patient. One option is to repair the patient’s own existing ligaments with stitches. This repair is often made stronger by support from other tissues. This is referred to as the modified Bröstrom procedure. Another option is to use a tendon to replace the torn ligaments. This technique is similar to what is done in knee ligament reconstructions.
The modified Bröstrom procedure is the most commonly performed surgery for this problem. The surgeon begins by making a C- or J-shaped incision over the outside of the ankle. The ankle ligaments are identified if possible.They are then tightened using either stitches or anchors that are placed into one the bones of the ankle (the fibula bone). Stitching other tissue over the repaired ligaments further strengthens the repair.
Tendons may also be used to replace the ligaments. The surgeon weaves a tendon into the bones around the ankle. The tendon is held in place with stitches and possibly a screw in the bone. One option is to use the patient’s own hamstring tendon, which is taken through a separate incision on the inside part of the knee. Another option is to use a cadaver tendon. A different method is to take a portion of one of the tendons from the side of the ankle and weave it into the fibula bone.
What happens after surgery?
You can expect to be in a splint or cast for a minimum of two weeks. It may be up to six weeks before weight can be placed on the ankle. Weight bearing is gradually advanced in a removable walking boot. An athletic ankle brace is typically used after the boot.
Ankle strengthening begins after six weeks as pain and swelling allow. This may involve formal physical therapy. Straight-line running is allowed when the ankle is strong enough for it. Sport-specific exercises can then start gradually. The total expected recovery time is between six and 12 months.
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Patients commonly have decreased feeling around their incision. It is also common to have decreased feeling that extends to the top of the foot. This occurs up to 20 percent of the time and ranges from increased sensitivity to complete loss of sensation. Other less common problems include delayed wound healing and infection. Blood clots within the veins of the leg can also occur.
Frequently Asked Questions
What is the risk of retearing my ligament after it has been repaired?
Tearing of the ligament can have many definitions. Complete tearing can occur but usually only after repeat injury. However, repaired ligaments can stretch out over time. Long-term studies that look at these surgeries and patient satisfaction have shown that more than 90 percent of patients have a good or excellent outcome.
What if my ankle instability does not improve after surgery?
The results of surgery vary based on the severity of the initial injury. Outcomes will vary as well. Patients who have persistent instability after surgery may improve with physical therapy or by wearing a brace. Additional surgeries to reconstruct the ligaments may be an option. Ankle fusion could also be considered.