Introduction
One of the most frequent sports-related injuries is an ankle sprain. One could have pain and a sense of instability in the ankle if the ligaments on the outside of the ankle are strained or torn. Surgery can be necessary if these symptoms do not go away following non-surgical treatment. Restoring the ankle's normal stability is the aim of ankle ligament reconstruction. Lateral ankle ligament reconstruction is supposed to repair the 'giving out' sensation one has been having in the ankle and alleviate any pain that comes with an unstable ankle.
What Is Lateral Ankle Ligament Reconstruction?
One or more ankle ligaments on the outside of the ankle can be tightened and firmed up through a procedure called lateral ankle ligament reconstruction. It is also referred to as the Brostrom method. The majority of the time, it is an outpatient procedure, allowing patients to return home the same day. Ankles are hinge joints that allow for up-and-down and side-to-side motion. There are several ligaments in the foot and ankle. The bones in the ankles and feet are held together by these sturdy, band-like structures. Many ligaments are located on the outside of the foot. They include the calcaneofibular ligament (CFL) and the anterior talofibular ligament (ATFL). They aid in stabilizing the ankle and foot while walking.
The ligaments may start to weaken and loosen if one has sustained recurrent ankle sprains or if there are certain foot abnormalities, such as hindfoot varus, plantar flexion of the first ray, midfoot cavus, or certain medical conditions like Ehlers-Danlos syndrome. The ankle may become unstable if this occurs. A tiny cut is made on the outside of the ankle by the surgeon during lateral ankle ligament reconstruction. The ligaments on the outside of the foot are then tightened by the surgeon.
Who Needs Lateral Ankle Ligament Reconstruction?
If one or more of the ligaments on the outside of the ankle have become loose or strained, surgery may be necessary. Chronic ankle instability is a result of this. It can lead to persistent pain, frequent ankle sprains, and an ankle that frequently gives way when people walk or engage in other activities.
An ankle sprain may first stretch and partially tear the ankle ligaments. It is more likely that one will sprain the ankle again after this initial injury. This is more common if the initial sprain was not appropriately addressed. The ligaments may become looser with additional sprains. The likelihood of developing an unstable ankle may increase with certain mechanical issues with the foot, such as:
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Hindfoot Varus: Also known as supination or inversion of the subtalar joint, is the angulation of the foot away from the longitudinal axis of the calcaneal tuberosity.
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Plantar Flexion of the First Ray: Inhibits the tibia's medial (internal) rotation during early support, which impairs calcaneal eversion and the ability to absorb shock in the foot.
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Midfoot Cavus (High Arches): A condition when the foot has an excessively high arch. This disorder puts more weight than usual on the ball and heel of the foot while walking or standing, which among other symptoms, causes pain and instability.
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Ehlers-Danlos Syndrome: The ligaments are generally loose, for instance, as a result of an illness like Ehlers-Danlos.
Physical therapy and custom orthotics, such as shoe inserts or braces, might have already been used in the treatment. If alternative ankle treatments have not helped, a doctor might suggest surgery. It is uncommon to require this surgery immediately following a first ankle injury.
What Takes Place Throughout Lateral Ankle Ligament Reconstruction?
The lateral ankle ligament can be repaired using a variety of techniques. The specifics of the procedure should be discussed with the healthcare provider. The procedure will be carried out by an orthopedic foot surgeon. The procedure could last up to two hours, and it involves the following steps:
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Patients receive either a regional anesthetic to numb the affected limb or general anesthesia to put them to sleep throughout the treatment.
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All vital indicators, including heart rate and blood pressure, will be closely monitored throughout the procedure.
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The surgeon will make an incision through the skin and muscle of the ankle after cleansing the affected area.
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The surgeon will make a little incision if the procedure is minimally invasive. To execute the procedure, the doctor will insert tiny instruments and a camera through the incision.
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The ATFL and CFL ankle ligaments may be cut from their attachment points on the fibula by the surgeon.
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The surgeon may reduce the length of these ligaments.
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The ligaments may then be reattached to the fibula using tiny new holes that have been drilled into the bone by the surgeon.
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If more repairs are required, the surgeon may perform them.
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The ankle's muscle and skin layers will be surgically stitched together.
What Are the Complications of Reconstructing a Lateral Ligament?
Every surgery carries hazards, most of which are related to the anesthesia and the surgery itself. The anesthetist will be available before surgery to go through the anesthetic options and any potential dangers. The hazards associated with general anesthesia will change based on overall health. These are the primary surgical risks associated with lateral ligament reconstruction.
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Swelling - As a result of the procedure itself and the healing process, the ankle will swell after the surgery. The swelling is unlikely to subside in less than six months.
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Failure - There is a small possibility that the lateral ligament restoration will not succeed, necessitating another surgery. This frequently occurs after a second injury. By using the rehabilitation program to make sure that the ankle is strong and stable before resuming sports activities, one can minimize the danger.
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Nerve Damage - There is always a little chance that an operation can damage or strain the nearby nerves, which could result in numbness, although these symptoms typically go away with time.
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Infection - Normally, a wound heals in two weeks. The wounds can occasionally become infected. The majority of infections are small-scale and easily treatable with medications. On occasion, a patient may experience a deeper infection that necessitates further treatment.
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Blood Clots - After ankle surgery, there is a slight risk of developing a blood clot. While precautions are taken to lessen the likelihood of this occurring, it cannot entirely be avoided.
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Chronic Regional Pain Syndrome - It is a rare complication of foot and ankle surgery that can affect a small percentage of individuals. The foot develops permanent pain, swelling, and sensitivity. If a patient experiences this, they may need to see a pain consultant.
How Is Recovery After Lateral Ankle Ligament Reconstruction?
A splint or cast should be worn for at least two weeks. For up to six weeks, patients may need to avoid putting weight on their ankles. Using a detachable walking boot, patients are allowed to gradually place weight on their ankles. After the boot, it is common practice to wear an athletic ankle brace.
After six weeks, as soon as discomfort and swelling subside, ankle strengthening can be started. This might entail receiving formal physical therapy. When the ankle can sustain it, running in a straight line is acceptable. Then, gradually introduce sports-specific exercises. It may take six to twelve months for a complete recovery. Patients are encouraged to wear a brace when playing sports for up to a year.
Conclusion
When all non-operative options for treating ankle instability have been tried, and the symptoms are still severe, lateral ankle ligament reconstruction surgery is only advised as a last resort. As patients recuperate, the doctor or nurse will provide detailed advice on how to strengthen the ankle and leg muscles. However, most postoperative procedures call for a brief period of immobility, followed by bracing and functional rehabilitation. People who maintain a nutritious diet, engage in regular exercise, and give up smoking are more likely to have a quicker and more successful recovery from surgery.
