Ankle Ligament Repair Surgery

Ankle Ligament Repair Surgery

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Overview

Ankle joint is a complex joint that is formed by articulation of three bones, namely-tibia, fibula (long bones of the leg) and talus (bone of the foot). The joint acts as a shock absorber when the heel first strikes the ground. 

What is ankle ligament repair surgery?

When the ligaments of the ankle joint become unstable (too weak), torn or are damaged due to an injury or some underlying pathology, an ankle ligament repair surgery is recommended. The surgery aims at restoring the normal stability of the ankle and also treats associated symptoms.

What are the causes of ankle ligament injury?

  • Awkwardly landing on the foot after jumping
  • Walking or jogging on uneven surface
  • Falling from a height
  • Twisting of the ankle joint
  • Another player stepping on your foot during a sports activity
  • Wearing inappropriate (ill-fitted) footwear
  • History of previous injury to ankle joint

What are symptoms of ankle ligament injury?

  • Hearing a pop sound when injury occurs
  • Pain over ankle joint
  • Feeling of the joint “giving way”
  • Bruising
  • Tenderness
  • Swelling over the ankle joint
  • Difficulty standing or walking

How is ankle ligament injury diagnosed?

You should immediately visit your doctor in case you have injured your ankle joint and are experiencing any of the above-mentioned symptoms. Your doctor will perform a thorough physical examination of the joint and look for any kind of swelling, tenderness or deformity of the ankle joint.

Some special tests will also be performed to determine which ligament (MCL or LCL) is injured. While performing the physical manoeuvre, the doctor will assess stability of the joint and pain with movement. Next, an X-ray or MRI (magnetic resonance imaging) is ordered. X-rays are helpful in ruling out associated fractures of the ankle joint while MRI gives a clear image of the adjoining soft tissue structures (tendons, muscles and joint capsule) of the ankle joint. If required a CT (computerised tomography) scan or a diagnostic ultrasound of the ankle joint can also be performed.

How is ankle ligament injury treated?

First line of management for ankle ligament injury is always conservative approach. The patient is advised to follow RICE principle –

  • Resting the joint: avoid any activity that causes pain. Stop participating in any sports activities. In general, avoid all activities that require you to stand or walk.
  • Icing: wrap the ice pack in a thin towel and apply it on the affected area. Icing will help in reducing pain and swelling. This should be done for 20 to 30 minutes, 3 to 4 times a day to achieve maximum benefit.
  • Compression: wrapping the ankle joint with an elastic bandage (ACE bandage) will help in reducing swelling. The bandage should be wrapped firmly and not too tight otherwise it will hamper the blood circulation.
  • Elevation: compression along with elevation will help in draining away extra fluids around the ankle joint. This can be achieved by placing a few pillows below the injured foot. Elevation should be above the level of heart and should be done especially at night.

Your doctor will prescribe nonsteroidal anti-inflammatory (NSAIDS) medicines to relieve pain and ease swelling. As the pain subsides gradually, your doctor will recommend you to start a rehabilitation program with a physical therapist to strengthen the weakened muscles and improve stability.

Surgical treatment

In case the patient does not respond to 6 months of conservative treatment, then often surgery is recommended. Also, patients who have failed physical therapy rehabilitation and continue to have instability of the ankle may consider surgery. The type of surgery depends on the severity of symptoms and activity level. The two main options include-

Arthroscopy: minimally invasive surgical procedure to look inside the joint and determine the extent of ligament damage. Minor tears can be arthroscopically repaired.

Ligament repair surgery: this procedure is usually performed to treat severe ankle instability or major tears of the ankle ligaments. During this procedure the damaged ligament is reconstructed using a nearby ligament or tendon.

What happens before ankle ligament repair surgery?

You will be asked to completely stop smoking, as smoking delays the healing process. It is very important to inform your doctor about all the medications that you are currently taking, e.g., herbal medicines, nutritional supplements, pain relieving medicines and over the counter (OTC) medicines. Some of these medicines/supplements can increase the risk of complications after tendon repair surgery. You will be asked to fast and not eat or drink anything at least 8 hours prior to surgery or as directed by your doctor.

What happens during ankle ligament repair surgery?

  • The ligament repair surgery is usually performed under local anaesthesia. However general anaesthesia can also be used depending on the patient’s overall health.
  • The surgeon begins with making a small incision over the affected area and will cut through the skin and the muscles.
  • A tiny camera with attached light and small surgical instruments are then inserted into the joint through the incision.
  • Tendons are used to replace the damaged ligaments and these are held in place with the help of stitches/screws. Tendons can be taken from your own body or from a cadaver (dead body).
  • If the ligaments are lax (loose), these will be shortened and reattached to your bone by drilling small holes.
  • The surgeon will make other repairs, if required
  • Finally, the layers of skin and muscle around your ankle joint are surgically closed and a below knee plaster cast or splint is applied
  • The surgery usually lasts around 1 to 2 hours, and is performed as an outpatient procedure i.e., you will be discharged home the same day

What happens after ankle ligament repair surgery?

You will be moved to the recovery room and observed for a few hours before getting discharged. Expect some pain and swelling over the ankle joint for the first few weeks after the surgery. But these symptoms will gradually wear off. Your doctor will prescribe anti-inflammatory and pain-relieving medicines to help you feel better.Once you get back home, walking around (mostly for basic activities) should be done with the help of crutches. Avoid putting any weight on the operated joint during the first two weeks after the surgery. You need to wear the splint/cast for almost 10 to 14 days. After which your surgeon may replace it with a removable walking boot. An athletic ankle brace is typically used after the boot. It may take almost 6 weeks before you can put weight on the ankle.

After 6 weeks, your doctor will recommend you to begin rehabilitation with a physiotherapist. To begin with, simple ankle strengthening and stretching exercises can be performed. Sport-specific exercises can then be gradually started.Most of the patients will be able to resume their normal activities and sedentary jobs within a month after the surgery. Driving can be resumed almost 6-8 months post-surgery. However, it is recommended that you should always consult your doctor before doing so. The expected complete recovery time is around 6 to 12 months. It is recommended that patients should wear an ankle brace for up to a year while engaging in any sports activity.

What are the complications of ankle ligament repair surgery?

  • Infection
  • Excess bleeding
  • Blood clots
  • Infection
  • Nerve damage
  • Stiffness in your ankle joint
  • Pain in foot and ankle
  • Decreased movement of the ankle joint
  • Complications from anaesthesia
  • Early development of ankle arthritis

Tips for prevention

  • Proper warm up before engaging in any sport or exercising
  • Proper stretching of calf muscles (avoid bouncing during a stretch)
  • Avoid activities that put excessive stress on Achilles tendon (jumping)
  • Avoid running on uneven surfaces or slippery floors
  • Wear well-fitted athletic shoes with proper heel cushioning
  • Avoid wearing high-heeled shoes
  • Use an ankle support brace or tape on a previously injured ankle joint.
  • Slowly increase your training intensity, not more than 10% weekly

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