Ankle ligament surgery
Ankle ligament surgery
There are several types of ankle ligament surgeries depending on the ligament or ligaments affected, their presence or absence in the ankle, their presumed mechanical quality, and any associated injuries to the ankle or the subtalar joint.
Ankle ligaments can be repaired or reconstructed using ligament or tendon grafts. The surgical procedure is called ankle ligamentoplasty.
The different types of ankle ligament surgeries
Role of the ankle ligaments
The ankle ligaments provide mechanical stability to the ankle and contribute to proprioception, that is, the sense of the position of the ankle and foot in space. Certain conditions such as joint hyperlaxity can compromise this natural stability. The foot can be considered as a sensory receptor; its position during walking or running also depends on the position of the ankle. The stimulation of receptors on the surface of the ligaments helps to decrease the reaction time of the ankle stabilizing muscles.
Ligament repair
When the ligaments are present and have sufficient mechanical quality, they can be repaired. The goal is to recreate ligament tension by performing a transosseous capsuloligamentous reinsertion. This transosseous reinsertion can be performed using bone tunnels, or with anchors impacted or screwed into the bone.
Ligament reconstruction
In cases of absence of ligaments at the ankle, or when ligaments are present but of poor mechanical quality, it is possible to reconstruct the ligaments using a graft, or to repair and reinforce the ligaments with a graft. There are different techniques for ligament reconstruction.
Tendon grafts can be harvested from the knee, involving the hamstrings, or they can also be taken from around the Achilles tendon by harvesting the plantaris tendon. In case of a split tear of a peroneal tendon, the graft may be taken from the damaged tendon itself. Very strong surgical tissue strips can also be used to reinforce the ligament structures of the ankle. The extensor retinaculum can be partially used to reinforce or reconstruct a ligament bundle, as can the periosteum (the nurturing membrane of the bone) at the level of the fibula.
Ankle ligament surgeries
Indications
Not all ligament injuries necessarily require surgical intervention. Depending on the patient studies, 20 % to 40 % of ankle sprains could progress to instability, chronic pain, or chronic painful ankle instability. Surgical intervention may then be proposed.
Treatment
Surgical treatment of ankle ligament injuries is considered in cases of instability, chronic pain, or chronic painful instability despite well-conducted rehabilitation.
Ligament repairs and ligament reconstructions depend on the presence or absence of ligaments in the ankle as well as their presumed mechanical quality. It will be necessary during the same operation to treat any associated articular and tendon injuries.
Anatomical factors that promote ligament injuries must also be taken into account and may need to be surgically corrected at the same time.
Postoperative immobilization and its duration are dictated by the overall injuries to be treated.
Conclusion
Ankle sprains are a very common reason for consultation in a trauma emergency department. Unfortunately, there is no consensus on management, knowing that 20% to 40% of sprains may become complicated. In our view, rehabilitation should always be undertaken after an ankle sprain in order to try to limit the risks of residual pain, recurrence, and therefore surgical intervention.
FAQ
The objectives of ankle ligament surgery are to stabilize the ankle to prevent new sprains and to limit intra-articular pain. Ligament stabilization of the ankle helps to limit or slow down the risk of progression to ankle osteoarthritis by reducing shearing stresses on the cartilage.
In the case of ankle ligamentoplasty performed under arthroscopy, immobilization is done with an ankle splint for 45 days, with immediate weight bearing. If the ligamentoplasty is performed via open surgery, immobilization is done with a plaster ankle splint without weight bearing for three weeks, then with an ankle splint allowing weight bearing for 3 weeks. Rehabilitation begins 45 days after surgery.
After surgical intervention on the ankle ligaments, cycling and swimming without fins can be resumed at two months postoperatively, straight-line activities such as jogging can be resumed at three months postoperatively, and pivot and contact sports can be resumed from 4 months postoperatively.