Ankle Ligament Surgery in Singapore
If your ankle repeatedly gives way or you continue to experience instability after a ligament injury, ankle ligament surgery in Singapore may be considered to restore stability and reduce the risk of recurrent sprains.
Ankle reconstruction surgery may be recommended for chronic ankle instability or more severe ligament injuries, particularly when non-surgical treatment has not provided sufficient improvement. The aim is to help you regain ankle stability and return to daily activities or sports more confidently.
Understanding Ankle Ligament Injuries and Instability
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 ankle 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.
Types of Ankle Ligament Injuries
An ankle ligament tear can affect different parts of the joint depending on how the injury occurs. These include the lateral ligaments on the outside of the ankle, the deltoid ligament on the inside and the syndesmotic ligaments above the ankle.
Lateral Ankle Ligament Injuries
The lateral ankle ligaments are located on the outside of the ankle and are commonly injured when the ankle rolls inwards during a sprain. Repeated injuries can lead to chronic ankle instability, with recurrent sprains or a persistent feeling that the ankle may give way.
The Brostrom-Gould procedure is used to reconstruct the lateral ankle ligaments. See more about this below.
Medial or Deltoid Ligament Ankle Injuries
The deltoid ligament is a group of ligaments on the inner side of the ankle. Deltoid ligament ankle injuries can occur on their own or together with injuries to other ankle structures.
Treatment depends on the severity of the ligament damage and whether the ankle remains stable. Surgery may be considered for selected patients with persistent or significant medial ankle instability.
High Ankle Ligament Injuries
A high ankle sprain affects the syndesmotic ligaments that connect the tibia and fibula above the ankle joint.
Treatment depends on whether the syndesmosis remains stable. Stable injuries may be managed without surgery, while unstable injuries may require surgical treatment to restore stability.
When Ankle Ligament Surgery May Be Recommended
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.
Brostrom-Gould Ankle Ligament Reconstruction
The Brostrom-Gould procedure is one of the most common and simple procedures to reconstruct the ankle ligaments. It is an effective way of restoring stability to the ankle, allowing the patient to return to sports and protecting the ankle for the years to come.
During the procedure, the damaged lateral ankle ligaments are repaired and reinforced to restore stability to the ankle. Suture anchors may be used to secure the repaired ligament tissue to the bone.
Brostrom-Gould surgery can also be performed using minimally invasive techniques in suitable patients. The surgical approach will depend on the ligament injury, the condition of the existing ligament tissue and the individual patient.
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.
Ankle Ligament Reconstruction Procedure
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.
The suture anchors help secure the repaired ligament tissue to the bone while it heals. Ankle ligament reconstruction surgery may also be performed using minimally invasive techniques in suitable patients, depending on the ligament injury and the surgical approach required.
Recovery and Rehabilitation 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.
Post-Operative Pain
Pain and swelling are expected during the initial period after ankle ligament surgery. The amount of discomfort and how long it lasts can vary depending on the procedure and individual recovery.
Pain should generally improve as the ankle heals. Your surgeon will advise you on pain relief and swelling management after surgery. Increasing pain, redness, wound discharge, fever or other unexpected symptoms should be reviewed by your medical team.
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.
Potential Risks and Outcomes
Risks and Complications
As with any surgical procedure, ankle ligament surgery carries potential risks and complications. These can be managed by following post-surgical care instructions and diligently participating in physiotherapy.
- Infection.
- Numbness of the skin just around the wound.
- Stiffness of the ankle.
- Failure of the ligament repair.
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.
- Use of minimally invasive techniques in suitable patients.
- Protecting the long-term health of the ankle.
By addressing the underlying instability, ankle reconstruction surgery has the potential to improve quality of life and enable individuals to return to their desired activities.
Meet Our Orthopaedic Specialists for Ankle Ligament Surgery
Ankle ligament surgery at Centurion Orthopaedic Centre is performed by orthopaedic surgeons Dr Bruce Ang CL and Dr Tan Shi Ming.
Our surgeons have performed the Brostrom-Gould procedure for patients ranging from recreational runners to competitive athletes.
Dr Bruce Ang CL
Dr Bruce Ang CL is a Senior Consultant Orthopaedic Surgeon at Centurion Orthopaedic Centre. He has more than 20 years of orthopaedic experience and has performed more than 6,000 orthopaedic surgeries. His experience includes keyhole or arthroscopic surgery of the ankle and other joints.
Dr Tan Shi Ming
Dr Tan Shi Ming is a Senior Consultant Orthopaedic Surgeon who underwent subspecialty training in foot and ankle surgery in Bristol in the United Kingdom, Basel in Switzerland and Grenoble in France. His fellowship training included minimally invasive percutaneous and arthroscopic surgical techniques.
Ankle Ligament Surgery Cost, MediSave and Insurance
The cost of ankle ligament surgery in Singapore varies depending on the procedure required and where the surgery is performed.
Factors that may affect the final bill include:
- The type and extent of ligament injury.
- Whether the ligament is repaired or reconstructed.
- Whether additional ankle procedures are required.
- Suture anchors or other implants used.
- Surgeon and anaesthetist fees.
- Hospital and operating theatre charges.
- Day surgery or inpatient admission.
- Imaging, medication and follow-up care.
The Ministry of Health publishes hospital bill information and fee benchmarks for surgical procedures in Singapore. The applicable benchmark depends on the procedure code used for your surgery.
Ask the clinic for an itemised estimate once your surgeon has assessed your ankle and confirmed the procedure required.
MediSave
MediSave may be used for eligible surgical procedures, subject to the applicable procedure and prevailing MediSave withdrawal limits.
The clinic can advise you on the applicable procedure code and estimated MediSave claim before surgery.
Insurance
Insurance coverage depends on your individual policy and the procedure required. Pre-authorisation or a Letter of Guarantee may also be required by your insurer.
Check your coverage, panel requirements and expected out-of-pocket costs before proceeding with surgery.
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?
Outcomes after ankle ligament surgery depend on the type of ligament injury, surgical procedure, associated ankle injuries and individual recovery. Studies of the Brostrom-Gould procedure for chronic ankle instability have reported a high percentage of improvements in ankle stability and function, although individual outcomes vary.
How long does pain last after ankle ligament surgery?
Pain is expected during the initial recovery period after ankle ligament surgery and should generally improve as the ankle heals. The first three days after surgery may have more pain, but generally it should get comfortable from the fourth day onwards.
Your surgeon will provide instructions for managing pain after surgery. Seek medical advice if pain becomes significantly worse or is accompanied by increasing redness, wound discharge, fever or other unexpected symptoms.
When can I walk after ankle ligament reconstruction?
Immediately after surgery, the ankle is protected while the repaired ligament begins to heal. Initial care may include limited weight-bearing with crutches as tolerated, followed by conversion to a walking boot after one week.
Patients will recover gradually until they are able to walk smoothly at around 1.5 months after surgery. Your individual timeline may vary depending on the procedure and your recovery.
Is surgery always necessary for a torn ankle ligament?
No. An ankle ligament tear does not always require surgery.
Conservative treatments such as physiotherapy and bracing may be used first. Surgery is typically considered when these treatments fail to provide adequate relief from chronic ankle instability or in cases of acute injuries with significant ligament damage.
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.