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Surgery for Ankle Ligament Reconstruction

Surgery
Surgery to reconstruct the lateral ankle ligaments is done as an outpatient. You will require a general anesthetic.

                       Brostrom Incision.jpg

During the surgery I will make a curving incision over the lateral side of the ankle, usually 4 inches in length.

                           Ankle Ligament Reconstruction.jpg

The two lateral ankle ligaments are detatched from the fibula bone, and “peeled back”. I will shorten them and weave stitches into each of them. I will drill several small holes in the end of the fibula at the site where the ligaments will be re-attached. The stitches are then passed through the drill holes and the shortened ligaments are sewn back into the bone.

During this operation the peroneal tendons on the lateral side of the ankle are inspected. If there is any problem with them, they can be repaired at the same time as the ligaments.  In some instances, an ankle arthroscopic examination is done at the same time.

Day of Surgery
At the end of the surgical procedure the wound is covered and a short leg plaster splint is applied. That dressing gives support to your ankle, holding it securely. You should leave that in place until I change it at the first post-operative office visit.

You will be given crutches at the surgery center, and I want you to not put any weight on that leg during the first week.  Do not walk on the splint.  If the splint gets wet or there is a problem with it, please call the office so I can remove it myself.

Look here for things to watch for after outpatient surgery.

Post-operative Course
Dealing with post-operative pain will be your major concern for the first few days.  Try to keep your foot elevated to minimize swelling.

Most people find that for the first few days after surgery their ankle will feel better if it is elevated. Generally, if you let it hang down for any period of time it will throb and you may have more swelling. You can put it into whatever position feels best, but usually that will be elevated with a pillow under the foot.

                       Brostrom Wound.jpg

The first post-operative visit is usually 7 – 10 days after surgery. I will remove the splint and dressings, wash your leg, and take out the skin stitches.

I will then put you into a short leg walking cast, so you will not need to use the crutches or walker. You will wear this for 4 weeks. It can not be removed. This will ensure that the ligaments are protected while they heal back into the bone.

The second post-operative visit is usually at the 5 week point. At that time I will remove the cast, and check to make sure that everything is healing satisfactorily. I will then have you go into a Stirrup Ankle Brace that you wear with an athletic-type lace-up shoe. You may walk using this brace and shoe as much as it feels comfortable. You should not do any activities more vigorous than walking for 4 more weeks. You may remove this for bathing and sleeping, and to do gentle range-of-motion activities.

I will ask to see you one more time after an additional 4 weeks, 2 ½ months after surgery. At that time we may discuss doing physical therapy. Usually, about 1 out of 4 patients will benefit from physical therapy. You may then walk without the ankle brace. You must use the brace for an additional month when doing athletic activities.

Most patients have swelling about the surgical area that lasts for about 4 months after surgery.

Final Results
The goal of the surgery is to leave you with a painless ankle that will allow normal activities. You should be able to regain full strength and power in the leg, and have no restriction of motion. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes.

Complications
Complications can occur with any surgery.  Go here for a general discussion of Surgical Complications.

A specific risk of this surgery is that when the swelling resolves some patients can feel the tiny knots in the stitches used to sew the ligaments back to the fibula bone. They are rarely bothersome, but if they are they may need to be removed after 6 – 9 months with another outpatient surgery.




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