Ankle Ligament Repair

Ankle Ligament reconstruction, Modified Broström-Gould Repair
Summary

This operation is performed for ankle instability and pain caused by previous injuries to the ankle ligaments on the outer aspect of the ankle.  The aim of the operation is to repair the torn ligaments to restore the normal stabilisers around the ankle joint. 

Factors to Consider

Ankle sprains are common and normally cause damage to the ligaments on the outer aspect of the ankle.  Recurrent ankle sprains can lead to insufficiency in these ligaments, which increases the chance of further ankle sprains.  

It is likely that you have already tried non-surgical treatments for your ankle instability such as physiotherapy and braces.  If these measures have not improved your symptoms then the next logical step is to consider surgery.

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is usually performed through a short incision on the outer side of your ankle.  The surgeon will then identify the torn ligaments and secure them back onto the fibula bone.   If the ligaments are severely damaged the surgeon may augment the repair using a synthetic ligament.  The surgeon may also perform an ankle arthroscopy to clear the joint of any debris.  

The operation takes about 1 hour.

Anaesthetic

The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The main risk for this operation is recurrence of symptoms.  The ankle joint relies on proprioception (the body’s way of sensing where your ankle is in space) to control the ankle joint in normal daily tasks.  Recurrent ankle sprains cause a loss of proprioception and this needs physiotherapy to “retrain” the ankle joint.

The risk of infection is small and is thought to be about 1%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the foot can occur but this is rare.  

Any surgery to the ankle may increase the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last 12-24 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Plaster

You will wake up with your foot in a plaster.  This is kept on for the first 2 weeks to allow the wounds to heal.  You will not be allowed to weight bear during the first 2 weeks.  It is likely that your foot will be placed in a walking boot at this stage and you will be encouraged to weight bear in your boot for the next 4 weeks.  The surgeon will give you instructions specific to your operation regarding your weight bearing status.

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but normally takes about 6 weeks, unless your surgery is on your left ankle and you drive an automatic car.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take over  6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Your symptoms should be approximately 80% better by 3 months with the majority fully recovered by 6 months.  It can, however, take up to a year for some patients to fully improve.