ANKLE RECONSTRUCTION SURGERY – LATERAL ANKLE LIGAMENT RECONSTRUCTION

Image Credit: Patient Education Videos 

“Keeping your body healthy is an expression of gratitude to the whole cosmos – the trees, the clouds, everything.”
– Thich Nhat Hanh

Lateral Ankle Ligament Reconstruction

There are some orthopaedic ailments that require surgery to restore. In the process of healing loose ankle ligaments, your orthopaedic surgeon may opt to perform a lateral ankle ligament reconstruction. This process, aims to tighten loose ligaments and allow them to maintain the tension that is necessary to maintain optimum ankle flexibility and movement. The good news about the lateral ankle ligament reconstruction surgery or Brostrum procedure is that patients are free to return to their homes post procedure.  As a hinge joint, the ankle facilitates rotation, as well as up and down and side to side motion of the feet. The critical ankle ligaments are what enable the critical motion to be facilitated and for the appropriate foot support to be enabled. For those individuals who are prone to repeated ankle sprains, the ligaments are likely to be stretched in the process. Loose ligaments lead to ankle instability. To correct the procedure, your orthopaedic surgeon will make a small incision right outside the ankle, which then facilitate access to the ligaments for treatments. This incision is part of that advent of medicine known as minimally invasive surgery. Done under general anaesthesia, you will feel minimal pain and a fast recovery.  

How do you know if you need Lateral Ankle Ligament Reconstruction Surgery? 

After an orthopaedic consultation, your doctor will be able to determine if you will be a recipient of the surgery. Via a series of assessments such as X-rays that permit internal imaging of your ankle, your doctor will be able to analyze your ankle and determine the path forward. Initially, you’ll experience chronic ankle pain, and the propensity for your ankle to “slip” when you are doing something strenuous such as walking for exercise or participating in sports activities. All of these activities eventually lead to a stretching of the ankle ligaments, and may also partially tear the ligaments. There are also a myriad of root causes of an unstable ankle, which are not limited to, but inclusive of the following [ ref 3]: 

  • Hindfoot varus
  • Plantar flexion of the first ray
  • Midfoot cavus (high arches)
  • General looseness of your ligaments. For example, from a health condition such as Ehlers-Danlos.

When physical therapy and orthotics aren’t helping you to advance your healing, surgery is often recommended as the next best option for treatment. As a preventative measure, if you just experienced your first ankle sprain, your orthopaedic surgeon may recommend lateral ankle ligament reconstruction as a preliminary healing procedure. This will prevent further damage down the line. 

According to the University of Rochester’s Medical Dictionary, the surgical risks associated with lateral ankle ligament surgery include:

  • Excess bleeding
  • Nerve damage
  • Infection
  • Stiffness in your ankle joint
  • Blood clot
  • Complications from anesthesia
  • No improvement in your ankle stability

Having discussions with your orthopaedic surgeon will prepare you for the surgery, and enable you to be mentally and physically ready for the procedure. 

ANKLE LIGAMENT RECONSTRUCTION SURGERY

Within the ankle reconstruction sphere, there are various iterations of the Brostrum procedure which is a type of keyhole surgery that facilitates the tightening of the ankle ligaments. With time, the expansion of the treatment options also includes an option to repurpose a tendon, in order to facilitate the internal tension restoration in the hinge. Statistically, up to 85% of all ankle injuries involve the lateral ankle ligament complex. With the two aforementioned procedures, the prevention of downstream problems such as degenerative arthritis will be the ultimate advantage. With life expectancies increasing, mobility will be critical and maintaining the ankle joint will facilitate that desire. Orthopaedic surgeons will be the key to ensuring that your feet are in good health. 

Within your ankle, there are three main ligaments: 

  • The anterior talofibular ligament (ATFL)
  • The calcaneofibular ligament (CFL) 
  • The posterior talofibular ligament (PTFL)

The most commonly affected during sprains is the ATFL. Using a little physics and engineering, your orthopaedic surgeon will assess in detail, the extent of damage that has been experienced by the injury in question. Based on the dimensions of the feet, detailed calculations will be done, identifying what the restored dimensions of the feet should be. If there is adequate tissue to reconstruct the foot, the surgical procedures will be executed by your foot and ankle surgeon. 

Advances in orthopaedic surgery have identified reconstructive techniques to be quite efficient. The ultimate results indicated by both the patient experience and their x-rays, have indicated that ankle instability is generally restored. The majority of athletes who underwent the treatment were able to return to their sport within a few months of the procedure. Treatment takes approximately three months. During this interim, there are plenty of activities that you can use to keep yourself engaged in the healing process. Gentle exercises will be prescribed by your foot and ankle surgeon that will facilitate your peak joint restoration. 

POST OPERATION

As an outpatient procedure, it is possible for you to return home after your surgery. You will typically be monitored by your medical team for a few hours after your surgery. You will be under general anaesthesia, and will awaken after a few hours. Post surgery treatment includes the wrapping of the ankle with a splint. As a patient, you won’t be able to drive, so arrange to have a friend or family member pick you up after the procedure. Pain management will also be critical once the anaesthetic wears away. Your orthopaedic surgeon will prescribe appropriate treatments for you. These may include prescription pain medications or the use of over the counter pain medications such as Ibuprofen or Acetaminophen. Keep your movement to a minimum and keep your leg elevated to minimize healing. 

In order to facilitate your movement, you will need crutches as part of your post surgery tools. During your surgical plan, all of these items will be organized and arranged. You will require these items for a few weeks, before you are cleared for natural mobility. 

Article References: 

Results of Anatomic Lateral Ankle Ligament Reconstruction with Tendon Allograft:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145865/

Ankle Reconstruction Surgery:
https://www.mymosh.com/services/ankle/ankle-ligament-reconstruction/

Lateral Ankle Ligament Reconstruction Surgery: 
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=135&contentid=343

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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