Ankle Ligament Reconstruction

What is ankle ligament reconstruction?

Ankle ligament reconstruction is a surgical treatment for ankle ligament injuries and instability.

A sprain is an injury to a ligament (which connects a bone or bones to a joint). Ankle sprains are usually caused a sudden overstretch due to twisting or rolling the ankle. Sprains are graded on severity:

  • A grade 1 sprain is when the ligament is mildly damaged — it has been slightly stretched, but is still able to help keep the ankle joint stable
  • A grade 2 sprain is when the ligament is stretched to the point where it becomes loose — this is often referred to as a partial tear of the ligament
  • A grade 3 sprain occurs when there is a complete tear of the ligament — the ligament has been split into two pieces, and the ankle joint is unstable

Depending on the tear, surgery may involve repair, that is stitching the ligament back together or reconstruction where a tendon is used to replace the torn ligaments. Commonly, the ligament is repaired, but also reinforced by stitching other tissues over the repair.

Do I need ankle ligament reconstruction?

Once a ligament has been torn in two, it will not repair itself. If your ankle is unstable, surgery may be an option for you. However, in many cases a period (eg 6 months) of non-surgical therapy is tried before surgery.

How does ankle ligament reconstruction work?

Ankle ligament reconstruction may be done under a combination of general, regional or local anaesthesia. It is usually a day procedure, meaning you can go home on the same day as the surgery.

Sometimes your surgeon start by performing an ankle arthroscopy to examine the inside of the joint before moving on to ligament repair.

To perform the ligament reconstruction, your surgeon will make a J or C shaped incision over the outer side of your ankle. The ligaments are located and then anchored to the bone, ensuring that they have been pulled tight enough to create a stable ankle. The ligaments may be reinforced by stitching other tissues over the repair.

If the ligaments cannot be repaired, a tendon may be used to replace them. Potential tendons include your own hamstring or other ankle tendon. An option is a tendon from a cadaver. Your surgeon will weave the tendon around the bones and fixed into place with stitches and/or screws.

Once the repair is finished, the incisions are closed and the wound is covered with a dressing. You will probably be fitted with a splint or cast.

What to expect after ankle ligament reconstruction surgery

It’s normal to feel some discomfort when the anaesthesia wears off, however simple pain medications are usually enough to keep you comfortable. Try to elevate your foot as much as possible at first to reduce swelling and pain

The cast or splint will be on for about 2 weeks. You won’t be able to bear weight on the affected leg, so you will need crutches.Before you leave the hospital, your therapist will help you walk safely with the crutches and show you some exercises to start your rehabilitation program.

Your stitches will be removed 10–14 days after surgery, at this stage your cast may be swapped for a removable walking boot. You may be able to start partially weight bearing, with the help of crutches. Your physiotherapist will continue to help you walk and prevent joint stiffness.

After around 6 weeks, you will probably be able to walk in the boot without crutches. At this stage your rehabilitation program will usually start to incorporatestrengthening exercises. Most people are able to resume driving around 6 weeks after surgery.

By 4–6 months you should be back to all your normal activities.