The movement of the ankle is supported and controlled by ligaments (tissue connecting bone to bone)present on the outside of the ankle joint. Injury caused to these ligaments by chronic or repeated ankle sprains reduces their ability to confine the ankle jointwithin the normal range of motion. The stretching or tearing of these ligaments may make the ankle unstableand result in the ankle giving way, difficulty in walking on irregular surfaces or chronic ankle pain. Ligament stabilization is a surgical procedure performed to shorten and tighten the stretched out ligaments; thereby,making the ankle more stable.
Ligament stabilizationin the ankle is indicated for the following conditions:
- Unstable ankle
- Recurrent ankle sprains
- Failure of the non-operative therapy, such as physiotherapyin showing improvement
- Patients who have reached their complete bone growth
The ankle ligaments can be stabilized using either surgical procedures below:
Brostrom-Gould procedure: This procedure uses local tissue to reconstruct and stabilize the stretched ligaments. It is performed under general anesthesia or local anesthesia with intravenous sedation. Your surgeon makes an incision on the outer side of the ankle and finds the stretched or torn ligament. Small holes are then made in the bone and the ligaments are repaired or tightened and attached to the bone with sutures. The skin is closed with dissolvable sutures.
Tenodesis procedure: This procedure is carried out when the ligament is so damaged that it cannot be repaired. Tenodesisinvolves theuse of tissues such as a tendon (tissue connecting muscle to bone)graft or a band of fibrous tissue graft, taken from other parts of the body, to replace the badly damaged ligaments. It is performed under spinal anesthesia or general anesthesia.Your surgeon will make a long incision over the ankle joint Holes are drilled in the ankle and foot bones to attach the grafts. Your surgeon will suture the free piece of tendon to the bonesat the location of the previously running ligaments. The skin is closed with sutures.
Following the surgical procedure, a complete plaster cast or plaster splint will be placed behind your ankle and under the foot. After the swelling has reduced, a plaster cast will be placed from the knee to your toes and you will be provided a plaster cast shoe to walk in. After 10-14 days, the plaster will be removed and a plastic splint will be applied which will allow your ankle to move in an up and down motion, but not side to side. You can resume a desk job within a few days, but you may require about 2-3 monthsof healing before resuming heavy manual work. You can gradually increase the activity of your ankle while wearing the brace as instructed by your physiotherapist. It may take around 6 months to return to sports.
Risks and Complications
As with any surgical procedure, ligament stabilization involves certain risks and complications. They include:
- Stiffness and failure to provide full flexibility,or looseness of the ankle (giving way of the ankle)
- Damage to neighboringnerves and blood vessels
- Ankle numbness
- Bleeding and infection at the site of repair
Advantages associated with the surgical procedures include:
- Brostrom-Gould: Minimum restriction of normal range of motion and good cosmetic improvement
- Tenodesis: Provides excellent ankle stability