Lateral Ankle Ligament Reconstruction

LATERAL ANKLE LIGAMENT RECONSTRUCTION

Ankle sprains are one of the most common sports-related injuries. They affect 10,000 people per day. When the ligaments on the outside of the ankle are stretched or torn, patients can have pain and feelings of instability. If symptoms persist after non-surgical treatment, surgery may be required. The goal of this surgery is to restore normal stability to the ankle. This should also fix your feeling that the ankle “gives way” and any pain that is associated with an unstable ankle.

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 called a modified Bröstrom procedure and can result in a stronger repair because of support from other tissues. 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.  

COMPLICATIONS
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Patients having ALR commonly have decreased feeling around their incision. It also is 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 in the leg veins also can occur. Recurrent ankle instability or stiffness also may occur.

FREQUENTLY ASKED QUESTIONS
  • What are the alternatives to surgery?

    Treatment for ankle instability typically involves bracing and physical therapy. Many patients will respond to this treatment. 

  • What can happen if ankle instability goes untreated?

    Repeat ankle sprains can occur. This can lead to ankle joint damage, bone and tendon injuries, and arthritis.

  • 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.

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Information provided by American Orthopedic Foot and Ankle Society (AOFAS) via FootCareMD.com
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