Ankle Ligament Surgery
Ankle ligament surgery in Singapore offers a potential solution for individuals with chronic ankle instability or severe ligament injuries. This surgical intervention restores stability, prevents recurrent sprains, and enables patients to return to their desired activity levels, whether it is playing sports or performing daily tasks with confidence. Ankle reconstruction surgery could provide long-term relief and improve the overall quality of life for those affected by ankle instability or recurrent ankle sprains, which is the most common sports injury worldwide.
What is Ankle Ligament Surgery?
Ankle ligament surgery encompasses procedures that aim to reconstruct or repair damaged ligaments in the ankle. These ligaments are crucial for providing stability and preventing excessive movement that can worsen any pre-existing instability or injury other structures such as cartilage.
Ankle ligament surgery is often necessary for individuals with chronic ankle instability, a condition characterised by recurrent sprains and a persistent sense of giving way. Instability also commonly manifests as pain of the ankle due to walking more or exercising. This can be due to a previous ligament tear or underlying Generalised Ligamentous Laxity. The surgery is commonly performed to address chronic instability or recurring sprains that haven’t responded to conservative treatments like physiotherapy and bracing.
Brostrom-Gould Procedure
The Brostrom-Gould procedure is one of the most common and simple procedures to reconstruct the ankle ligaments. It is a very effective way of restoring stability to the ankle, allowing the patient to return to sports and protecting the ankle for the years to come. This surgery is called Brostrom-Gould reconstruction surgery. This procedure reconstructs the lateral ankle ligaments.
When is Ankle Ligament Surgery Needed?
Ankle ligament surgery is typically considered when conservative treatments, such as physiotherapy and bracing, fail to provide adequate relief from chronic ankle instability or in cases of acute injuries with significant ligament damage.
Conditions Requiring Surgery
Here are some cases where ankle ligament reconstruction may be necessary:
- Frequent ankle sprains or instability.
- Generalised Ligamentous Laxity, which leads to recurrent injuries.
- Severe ligament tears or damage not responding to physiotherapy
- Exertional pain and swelling of the ankle.
Diagnostic Process
A thorough diagnostic process is crucial to accurately assess the extent of ankle ligament damage and determine the most appropriate treatment approach. This process involves a physical examination, a review of medical history, and imaging studies. MRI scans are commonly used to assess the extent of ligament damage and determine the need for surgery. During the diagnostic process, doctors look for signs such as:
- Persistent instability.
- Recurrent sprains despite conservative management.
An ankle Suture Anchor that is used for Brostrom-Gould surgery.
Preparing for Ankle Ligament Surgery
Preparing for ankle ligament surgery primarily involves pre-habilitative exercises designed to strengthen and stretch the ankle. These exercises play a key role in promoting a faster and smoother recovery. However, specific recommendations may vary depending on your individual condition and your surgeon’s guidance. Common preparatory measures include:
- Strengthening the ankle and calf muscles with tip-toeing and resistance exercises.
- Allowing significant swelling and inflammation from recent injuries to settle before surgery.
The exception for the above is in cases with severe ligament damage and internal blood clots. This is because immediate and early surgery could be better to allow early healing.
What to Expect During Surgery
If you’re considering ankle ligament surgery, it might be helpful to know what to expect during the procedure.
On the day of surgery, you will be admitted to the designated hospital at least 2 hours before the surgery time. The length of the surgery may be 45 – 60 min, but you may be in the operating theatre for about 2 to 2.5 hours in total.
During the surgery, the surgeon will make small incisions around the ankle to access the damaged ligaments. Depending on the extent of the injury, the ligaments will either be repaired or reconstructed using sutures and small plastic screws (suture anchors) that are inserted into the bone to allow the tissue to be repaired. These screws will integrate into the patient’s own bones after several years. Patients either undergo this as a day surgery or stay one night in the hospital.
Recovery After Ankle Ligament Surgery
Recovery after ankle reconstruction surgery is a gradual process that requires adherence to post-operative care instructions and a structured rehabilitation plan. Here’s what you can expect in order to achieve optimal healing and regain ankle function:
Initial Post-Surgery Care
Immediately after surgery, the focus is on protecting the repaired ligaments and minimising swelling in the ankles. This typically involves:
- Immobilisation with a cast to reduce movement.
- Elevating the leg to minimise swelling.
- Limited weight-bearing with crutches as tolerated.
- Conversion to a walking boot after one week.
Physiotherapy and Rehabilitation
Physiotherapy plays a vital role in restoring ankle strength, flexibility, and stability. You’ll likely begin physiotherapy 3 weeks post-surgery, with a focus on:
- Gentle stretching and strengthening exercises.
- Progressive recovery of ankle range of motion.
The overall recovery timeline may vary depending on individual factors and the complexity of the surgery. Here’s a general expectation of milestones:
- 1.5 Months Post Surgery: Walking smoothly.
- 2 – 3 Months Post Surgery: Starting to run.
- 4 – 5 Months Post Surgery: Returning to jumping sports (e.g., basketball, netball).
Driving
Return to driving can be almost immediate if your operated leg is on the left and you drive an automatic car. Otherwise, it may be 4 to 6 weeks after surgery before it is advisable to resume driving.
Time Away From Work
Time away from work is variable and depends on each patient’s work requirements. In our experience, it may range from two weeks to two months.
Risks and Complications
As with any surgical procedure, ankle ligament surgery carries potential risks and complications, including:
- Infection.
- Numbness of the skin just around the wound.
- Stiffness of the ankle.
- Failure of the ligament repair (although the failure rate for this treatment is very low)
Following post-surgical care instructions and diligently participating in physiotherapy can significantly mitigate these risks and promote optimal healing.
Benefits of Ankle Ligament Surgery
Ankle ligament surgery offers several potential benefits for individuals with chronic ankle instability or severe ligament injuries:
- Restored ankle stability and prevention of recurrent sprains.
- Improved confidence during physical activities.
- Faster recovery with minimally invasive techniques.
- A definitive, one-time solution to restore the structural stability of the ankle.
By addressing the underlying instability, ankle reconstruction surgery has the potential to significantly improve quality of life and enable individuals to return to their desired activities without the fear of repeated injuries.
Frequently Asked Questions About Ankle Ligament Surgery
How long does recovery take?
Recovery after ankle ligament surgery generally takes about 4–6 weeks for returning to basic activities such as walking without crutches. However, full recovery, including participation in sports and other strenuous activities, typically requires 3 to 5 months. The recovery timeline varies depending on factors such as the extent of the injury, the type of surgical procedure performed, individual healing rates, and adherence to the rehabilitation plan.
Will the screws need to be removed?
The screws used in ankle ligament reconstruction or ankle reconstruction surgery are typically plastic and biocompatible, designed to remain in the bone permanently. There are two types of screws:
- Bioabsorbable screws: These dissolve naturally over time.
- Non-bioabsorbable screws: These remain in the bone permanently.
In modern practice, screws generally do not need to be removed in the vast majority of cases.
Can I play sports again?
Returning to sports after this treatment is highly possible, though it requires a structured rehabilitation programme and a gradual progression of activity. The timeline for resuming sports depends on factors such as the type of sport, the level of competition, and individual recovery progress. Your surgeon and physiotherapist will evaluate your ankle’s stability, strength, and functional ability to determine when it is safe for you to return to your desired sport after surgery.
What is the success rate of this surgery?
Ankle ligament surgery has a very high success rate in restoring ankle stability, reducing pain, and improving function. Studies have shown success rates of 90-95% in achieving these outcomes.
See an Ankle Specialist Today
If you’re experiencing persistent ankle instability or chronic ankle pain that limits your daily activities or prevents you from enjoying your favourite sports, it’s crucial to seek the expertise of a specialist. Early intervention and proper diagnosis could significantly improve outcomes and potentially facilitate a faster return to your normal activities. Take the first step towards recovery and schedule a consultation with an ankle specialist today.