Ankle ligament reconstruction (ALR) is a surgical ankle procedure commonly used to address chronic ankle instability by repairing tears in ligaments and tightening ligaments that have become loose. Chronic ankle instability is typically the result of repeated ankle sprains or a severe sprain that did not adequately heal.
As a hinge joint, the ankle is designed for a wide range of movement, side to side, as well as up and down. The connective tissue around the ankle, especially the ligaments, hold the joint together and, at the same time, have the flexibility to allow for all of the movements that we ask of our ankles. When those demands are too much, it can result in an ankle sprain, which may cause one of the ligaments around the ankle to be stretched or, in some cases, even torn.
Repeated ankle sprains or more severe sprains that do not completely return to normal can lead to chronic ankle instability. Ligaments that have been over-stretched too often or too severely can lose the ability to provide adequate support for the ankle. Tears resulting from more severely sprained ankles that do not adequately heal can cause pain, instability, and balance issues. Both over-stretching and tearing increase the likelihood of future ankle sprains and the experience of the ankle “giving way” even when simply walking or standing.
Symptoms of Chronic Ankle Instability
Ankle sprains are very common. Most probably never require professional medical care, but more than 23,000 people in the U.S. do make appointments with their doctors every day due to sprained ankles. Most of those heal with rest, ice, compression, and elevation. However, around 20 percent of acute ankle sprains result in the development of chronic ankle instability.
Those with ongoing or chronic ankle instability commonly experience some or all of these symptoms:
- Inability to depend on the affected ankle to not turn or give way during activities or when walking on uneven surfaces
- Presence of pain, usually on the outer side of the ankle, and swelling on a consistent basis
- Tenderness around the area of the ankle
- The affected ankle feels “different”, more wobbly and less stable than the unaffected ankle
Ankle Ligament Reconstruction for Chronic Ankle Instability
Once it has been determined that your chronic ankle instability is persistent and that more conservative methods of treatment have proven inadequate, your orthopedic surgeon will likely recommend ankle ligament reconstruction surgery. The procedure will typically be performed as an outpatient procedure and general anesthesia will be used for sedation.
Torn ligaments may be repaired with stitches or sutures. Ligaments that have been over-stretched or disconnected may be reattached. Tendons from another area of the body may be used to repair a ligament when there has been too much damage to stitching back together.
The surgeon will have different techniques to choose from for the repair and will determine which to use in repairing the ligament based on the condition of the ankle and the health of the patient. The most common technique used in repairing damaged ankle ligaments is the modified Bröstrom procedure. In this type of surgery, the surgeon makes a C- or J-shaped incision along the ankle on the outside of the joint. Once the affected ligament is identified, stitches may be used to tighten the tissue and restore stability, or one or more anchors may be used to attach the ligament to one of the bones in the ankle, usually the fibula.
When a tendon from another part of the body is used to replace severely damaged ligaments, the surgeon will weave it through the bones that make up the ankle joint. It will then be secured with stitches or anchored to the bone. These tendons are often taken from the patient’s own body, like using the hamstring, which is located in the knee but may also come from cadavers.
Recovery from Ankle Ligament Reconstruction
Following ankle ligament reconstruction surgery, patients can expect to be in a cast or splint and on crutches for around two weeks. Once the cast or splint is removed, it will likely be replaced with a removable walking boot. Your surgeon will give you instructions on when your ankle will be able to bear full body weight.
Physical therapy will be recommended for about six weeks following surgery, depending upon any remaining pain or swelling, and will be an important part of a successful rehabilitation program. Using muscle-strengthening and range of motion exercises, the goal will be to gradually return full mobility to the ankle without undoing the healing process by placing too much stress or weight on the ankle before it is ready.
For most people, full recovery from ankle ligament reconstruction will take from three to six months. Sport-specific movements, especially those that require sudden starts and stops or changes in direction, may require a longer healing period before returning. This should always be discussed with your orthopedic surgeon.
Contact Dr. Christopher Hubbard Today
If you have suffered an injury or suffered from symptoms of chronic ankle instability, do not hesitate in reaching out to Dr. Christopher Hubbard today to discuss the possibility of ankle ligament reconstruction. He will take the time to understand your condition and take a personalized approach to diagnose and treat your issue. Contact us today to get started.