Ankle Sprain Surgery Overview

Soccer player getting his ankle kicked
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Ankle sprains are a common sports injury that can cause pain and swelling of the joint. In the vast majority of patients, non-surgical treatments will alleviate pain and restore function to the joint. However, there are some situations where surgery may be necessary to stabilize the ankle joint to allow a return to full activities for the patient.

Indications for Surgery After Ankle Sprain

In general, there are two situations where surgery may be considered.

  • Acute Injuries
    • The first situation is an acute injury, one that just recently occurred. In these situations, surgery is very seldom the treatment. Only in very severe injuries, in high-performance athletes, is surgery considered. These patients have usually sustained a Grade III ankle sprain and have clinical and x-ray findings of a severely unstable ankle. Early repair in these cases may help to speed recovery of athletic activities.
  • Chronic Instability
    • More commonly, surgery is performed when an athlete has recurrent symptoms of ankle instability (the ankle often gives out and is re-injured). These patients have usually tried simpler treatments including therapy, strengthening, bracing, and still have complaints of the ankle buckling.

Surgical Procedures - Modified Brostrom and More

There are dozens of different surgical procedures that have been described to stabilize the ankle in the setting of ankle instability. By far the most common surgical procedure used today is called the "modified Brostrom procedure." Dr. Brostrom initially described a surgical procedure, that has since been modified, and has become the most commonly used surgical procedure for ankle instability.

A modified Brostrom procedure essentially tightens the lateral ankle ligaments. Most often your surgeon will remove the bone attachment of these ligaments on the fibula, and reattach the ligament in a tighter position.

The Brostrom procedure is called an anatomic reconstruction because it attempts to restore normal ankle mechanics by restoring the normal anatomy. Other surgical procedures are considered non-anatomic reconstructions, as they involve using tendon reconstruction to limit the mobility of the ankle, thus preventing instability. These non-anatomic reconstructions are much less commonly performed. Names of the non-anatomic reconstructions include the Chrisman-Snook, Watson-Jones, and Evans procedures; again, all named after the surgeons who described the technique.

In some situations, the ligaments have been stretched out significantly, and repairing the ligaments may lead to persistent instability if the tissue is not felt to be strong enough. In these patients, some doctors prefer a non-anatomic reconstruction. Another option is to add tissue graft to the ligaments to add strength. In these situations, some surgeons recommend using a graft from another part of your own body, or a donor graft.

Ankle arthroscopy is becoming more commonly used as a component of ankle ligament surgery. Often the arthroscope is used to confirm the diagnosis and ensure that the cartilage and joint are in good condition. While ankle arthroscopy is not currently used as the procedure to repair damaged ligaments, this is becoming more commonly used in conjunction with ankle ligament surgery.

Surgical Recovery

Recovery after ankle stabilization surgery depends on the procedure performed. The results of surgery have been good, with studies of the modified Brostrom procedure showing better than 90% of patients resuming normal activities after their surgery.

Complications from surgery are most commonly encountered during the rehabilitation phase. Stiffness of the ankle joint or recurrent instability are both possible complications from stabilization surgery. Other risks include infection, wound healing problems, and nerve injury.

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Article Sources

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  • Maffulli N and Ferran NA. "Management of Acute and Chronic Ankle Instability" J Am Acad Orthop Surg October 2008; 16:608-615.