Ankle ligament reconstruction
Dr Jeff Ling & Dr David Lunz
Sydney Orthopaedic Specialists: Foot & Ankle Institute
The goal of this surgery is to restore normal stability to the ankle in the ankle which is prone to ankle sprains. This should also fix a patient’s feeling that the ankle “gives way” and any pain that is associated with an unstable ankle. Surgery is considered when you have an unstable ankle that does not respond to physiotherapy. A physical examination will show that the ankle is unstable, and X-rays and other imaging such as MRI are often used to help determine if there is associated injury to the ankle cartilage. The surgery is done under general anaesthesia, and other surgeries may be performed at the same time. This commonly includes an arthroscopic examination of the ankle joint. At least one larger incision is required for the ligament reconstruction.
The modified Brostrom also known as the “Brostrom-Gould” procedure, is the most commonly performed surgery for this problem and the gold standard of treatment. The surgeon begins by making an incision over the outside of the ankle. The ankle ligaments are identified and are then tightened using stitches and anchors that are placed into one of the bones of the ankle (the fibula bone). Stitching additional tissue over the repaired ligaments further strengthens the repair.
Tendons may also be used to replace the ligaments but this tends to be done in a revision setting when a Brostrom has failed. The surgeon weaves a tendon into the bones around the ankle. The tendon is held in place with stitches and special screws 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 method is to take a portion of one of the tendons from the side of the ankle and weave it into the fibula bone. We perform both types of procedure depending on the circumstances.
Protocol for post surgery rehab & physioWeeks 0-2
- Non weight bearing.
- The ankle is protected in a cast/boot.
- Weight bearing as tolerated.
- Start active ROM - NO inversion / NO passive or active assisted plantarflexion
- Wean boot.
- ROM X’s - NO inversion/NO passive or active assisted plantarflexion.
- Calf stretching.
- Upper ergometer.
- Bilateral stance proprioception.
- Theraband mm strengthening (except inversion)
- Start active inversion.
- Unilateral stance proprioception.
- Bilateral heel raises
- Start stairmaster/elliptical/treadmill/bilateral jumps progressing to unilateral
- Sports specific X’s progressing back to sport.
- Ankle brace for minimum 6/12 during sport.
Any surgical or invasive procedure carries risks. The information provided here is for general educational purposes only. Patients should discuss their particular situation with the doctors of Sydney Orthopaedic Specialists: Foot & Ankle Institute.