What are the indications for this surgery?
Surgery is considered when you have an unstable ankle (ankle ‘gives way’) that does not respond to non-surgical treatment. Three to four months of non-surgical treatment (physiotherapy and ankle rehabilitation) is often recommended before surgery. The goal of this surgery is to restore stability to the ankle.
Patients with nerve or collagen diseases may not be helped by this type of surgery. Other diagnoses, including ankle joint arthritis, may require different surgeries that treat the bones and joints. Chronic pain does not necessarily improve following surgery even once ankle stability has been restored.
How is the operation done?
You will be admitted on the day of operation. The operation takes about 1 hour and is routinely done under a general anaesthetic as a daycase procedure. Occasionally a spinal anaesthetic may be considered.
This procedure is often combined with an arthroscopy (keyhole) of the ankle. The ‘keyhole’ operation is undertaken first to identify and deal with any problems with the joint. In some patients, a concomitant joint problem may be present (e.g., cartilage damage) that may not have been detected on your pre-surgery MRI scan.
Following the arthroscopy (done through 2 small incisions) the lateral ligaments are reconstructed through a separate incision on the side of the ankle. Your existing ligaments are repaired / reattached with a bone anchor / stitches (see diagram below). This repair is often made stronger by support from other tissues. This is referred to as the modified Bröstrom procedure. Very occasionally (mainly in revision [re-do] cases), a tendon may be used to replace the torn ligaments.
The wounds are closed with dissolvable stitches. Your ankle will be protected in a boot for 6 weeks. You would be partially weightbearing on that ankle for the first 2 weeks.
Diagram showing the repaired lateral ligaments
Aftercare and FAQs
It is important to keep the leg elevated as much as possible especially for the first 2 weeks. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours. Your fist clinic follow-up is usually 12 to 14 days after surgery.
Wound care – The dressing should be kept dry. At yours first clinic appointment, would inspection and suture removal would be undertaken.
Work - If you have a sedentary job you should be able to return to work within 2 weeks (if you can arrange safe transport). If your job is physical, you may need to stay off work until the boot is removed.
Driving - You will not be able to drive for 6 weeks following surgery. However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 weeks following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.
Sport - You should avoid sport for at least 2 months from surgery. When to return to sport after that depends on the speed of recovery and type of sport (contact sport should be avoided for up to 4 months).
Essentially, you should not take part in sports until there is no further swelling within the joint and the leg is strong enough to exercise on comfortably. Advice from the doctor or physiotherapist is important in this regard.
What are the surgical risks?
Nerve damage — causing numbness and painful scar
Deep vein thrombosis (DVT) and pulmonary embolism (PE) — blood clots in the vein or lungs
Rupture of the reconstruction
Prolonged swelling and stiffness
Residual pain and instability
It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.