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Surgical Management of Chronic Ankle Sprains
Chronic or repeated ankle sprains result from
incompetence of the lateral collateral ankle ligaments. These ligaments
function to support and control motion within the ankle joint. When
these ligaments have been damaged from previous ankle sprains, they
lose their ability to restrain the ankle joint within its normal range
of motion. Typical symptoms include chronic ankle pain, difficulty
walking on uneven surfaces or a feeling of the ankle "giving way".
Initial treatment should consist of muscle strengthening and what is
referred to as "proprioceptive rehabilitation". This can be
accomplished through a physical therapist that is knowledgeable with
rehabilitation of lateral collateral ligament instability. An ankle
brace may also provide some external support to prevent recurrent
injuries and also control swelling. Surgical Stabilization of the Ankle Surgery
may be indicated for those cases of chronic ankle sprains failing to
respond to conservative treatment. There are various surgical options
available. These surgical procedures can be divided into two types. The
first type involves the use of local tissue to reconstruct the lateral
collateral ligament complex. The second type of surgery involves the
use of a tendon graft or some other type of graft material to
reconstruct the lateral collateral ligament complex. The
use of regional tissue is typically referred to as Brostrom-Gould
procedure. This procedure is usually performed as an outpatient. This
can be performed utilizing local anesthesia with IV sedation or a
general inhalation anesthesia. The type of anesthesia depends on the
surgeon and patient preference. Postoperative convalescence for this
procedure includes approximately 4 to 6 weeks in a non-weight-bearing
short leg cast. This is then followed by 2-3 weeks of protective
weight-bearing in a camwalker or brace. The patient will then progress
to standard footgear. This procedure has several advantages including
the use of local tissue without sacrificing normal anatomic structures,
very little restriction of normal range of motion and good cosmesis
with the incision placement. The second type of
surgical procedure is referred to as a tenodesis procedure. This
procedure involves a tendon or fascia latta graft that is routed
through drill holes within the ankle and foot bones. This is usually
performed as an outpatient and requires a general inhalation or spinal
anesthesia. Postoperative convalescence includes 6 weeks of
non-weight-bearing in a short leg cast. This is then followed by
protected wirht-bearing in a camwalker or brace for 3 to 6 weeks. The
patient will then return to standard footgear or rocker bottom brace
depending on the extent of swelling. Some patients may require physical
therapy but this will depend on the patient's specific situation. This
procedure has the advantage of providing excellent stability. However,
the stability can be at the expense of decreased joint motion and the
sacrifice of normal anatomic structures to reconstruct the lateral
collateral ligament complex.There are new allogenic grafts that have
been developed. This allows the surgical procedure without utilizing
normal anotomical structures. Ask your surgeon about this option. Possible Complications The
major complications following lateral ankle stabilization procedure
include decrease in subtalar joint motion. This joint is primarily
responsible for the foot's ability to swivel side to side. The other
complication not uncommonly seen includes sural neuritis. This is
secondary to excessive traction of the sural nerve during the surgical
procedure. Sural neuritis is usually transient and will resolve within
one year. Summary Lateral
ankle instability that fails to respond to non-operative care may
require surgical management. The type of surgical procedure depends on
the patient's activity level, occupation, weight and whether or not
previous surgery has failed. The patient should discuss the various
options with their surgeon to determine which procedure is best for
their situation. The ultimate goal is to have a patient function at
their pre-injury level and perform activities of a daily living without
continued ankle sprains.
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