Ankle Ligament Repair
Ankle ligament repair is a common orthopaedic procedure used to treat ankle instability. Most ligament tears lead to inversion episodes and it is these ligaments on the outer side of the ankle, which then need to be repaired with a technique known as a Broström-Gould procedure.
Why have the surgery?
If you have sprained your ankle severely, the ligaments that hold the ankle in place can either stretch or tear. If they do not heal properly, then the ankle will feel unstable and give way repeatedly. If physiotherapy cannot overcome this with muscle patterning (proprioception) exercises, then surgery may help.
How is surgery performed?
The operation is typically performed under a general anaesthetic. An incision is made on the outside of the ankle, and the injured ligaments are sectioned and repaired in a way that restores their original length.
What are the benefits?
Surgery is rarely performed acutely except in specific athletic populations, since the success rate of conservative treatment is so high. If that fails, then shortening the ligaments back to the pre-injury length will re-tension the ankle and stop it collapsing. This 'may' help reduce damage, and hence arthritis to the ankle joint.
What are the risks?
All operations have risks, but the commonest and most concerning for this surgery are: - Recurrence, meaning that the problem comes back. - Nerve damage, since the incision on the outer aspect runs in close proximity to a nerve known as the superficial peroneal nerve. Damage to this nerve can result in pain, number or a pain syndrome known as CRPS. - Blood clots, which can form in the leg and travel up to the lung where they can be fatal. This list is not exhaustive and Mr Patel can talk you through them all in more detail during a consultation.
What recovery is involved?
A plaster cast is used for between two and six weeks depending upon the strength of the repair, whether a patient is known to be hypermobile, and whether an augment such as an Internal Brace or other suture tape is used. Once the cast is taken down, physiotherapy can start and a pneumatic boot or brace is used for up to two months.
Any other considerations?
Not all patients with problems that are seen on a scan need surgery. Ligament repair is only indicated if non-surgical means have failed, and symptoms are severe enough to stop everyday functional tasks.