Ankle Ligament Surgery

Majority of ankle ligaments heal naturally. However, some with recurrent injuries or non-healing ligaments will need a surgery to either repair or reconstruct the ligament. A vast majority of ankle ligament injuries are on the outer side (lateral) of the ankle. Inner side (medial) ligaments are more sturdy and injuries are less common. 

 

Diagnosis

With good physical examination, the ATFL (anterior talo fibular ligament) and CFL (calcaneo fibular ligament) injury can be identified, however when the ankle is acutely swollen and painful, it may be difficult to examine.

X-ray. X-ray is performed and is useful to rule out any bone injuries, however, ligaments are not visible on the X-ray.

MRI Scan. MRI Scan is the gold standard investigation to identify the type and extent of the ATFL and CFL injury. In addition, it helps to assess the condition of the cartilage (smooth lining of the joint) in the ankle joint and other ligaments. These structures may be affected as well and need attention.

 

Treatment

First Aid for Ankle ligament injuries involves the typical R.I.C.E therapy for the first week.

Rest. It is important to minimize walking around.

Icepacks. Cold packs 3 to 4 times a day helps reduce the swelling

Compression. Crepe bandage is sufficient to help with compression.

Elevation. Keeping it elevated on a pillow when resting helps.

 

Chronic Partial tear of ATFL and/or CFL

Non-healing partial tears can be treated with PRP injection followed by plaster cast for 4 weeks. This has to be followed by foot stretches for 2 weeks post removal of the cast. This treatment can help heal majority of partial tears. In patients with no improvement with this treatment and in those with high grade 2 or grade 3 tears, surgery becomes necessary. 

Ankle Ligament Prehabilitation

Ankle Prehab exercises can be started once the pain and swelling improve. These help in regaining the knee movements and keep the muscles in a good condition.

Ankle ligament Surgery

  • Ankle ligament surgery is a day care surgery. There are various ways of reconstructing the torn ligaments. 

  • ATFL and CFL Reconstruction - using autograft

  • ATFL Reconstruction - Internal Brace using fibertape

  • Anatomic repair using imbrication (overlapping) of the lateral ankle ligaments

  • Anatomic repair using imbrication (overlapping) of the lateral ankle ligaments with reinforcement by extensor retinaculum (overlapping layer of tissue in the front of the ankle)

The torn ligament is either repaired or replaced by your own spare piece of tissue. The surgical technique is decided based on the nature of the tear and the expertise available to repair it. 

 

Graft material can be obtained from cadaver source (another person). However own tissue is preferred and the healing and take up of the material is better. One of the hamstring muscles from the inner side of the thigh is used. The spare muscle tendon is harvested through small keyholes. Usually the graft is fixed using bio-composite or PEEK (high grade polymer) suture anchors. 

 

Ankle Ligament Surgery Rehabilitation

Post-surger you can expect to be either in a plaster cast or walking boot. Early mobilisation is recommended. Partial weight bearing up to 3 weeks is advised. You will start non weight bearing stretches by 3 weeks. For full mobility it may take up to 6 weeks. To get back to running and other high impact activities usually around 4 to 6 months of time period is necessary.