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Ligament Surgery

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What Is Lateral Ankle Ligament Reconstruction?

Lateral ankle ligament reconstruction (LALR) is a surgery to firm up or tighten one or more ligaments of the ankle on the outer side of the ankle. It is also referred to as the Brostrom procedure. Usually, it is performed on an outpatient basis, and you can go home as soon as surgery is complete.

The ankle is a hinge-like joint that allows you to move from side to side or up and down. The foot and ankle are made up of numerous ligaments. Ligaments are robust band-like structures that tightly connect your ankle bones to the feet. The outer part of the foot has several ligaments that include the calcaneofibular ligament (CFL) and the anterior talofibular ligament (ATFL). These help to keep your foot and ankle stable when you walk.

When Do I Need Lateral Ankle Ligament Reconstruction?

If one or several ligaments on the outer part of the ankle has stretched or loosened, you may need this surgery. Loosened or stretched ligaments can lead to a condition known as persistent instability of the ankle. It can induce repeated ankle sprains, chronic pain, and your ankle can often give way when you are walking or performing other activities.

First, an ankle sprain may extend and cause a partial tear in your ankle ligaments. One sprain makes your ankle more susceptible to subsequent sprains. This happens primarily when your first sprain is not appropriately treated. As more sprains occur, they further loosen your ligaments.

Several mechanical foot problems can also make you susceptible to an unstable ankle. They include:

  • Midfoot cavus(high arches)
  • First ray plantar flexion
  • Hindfoot varus
  • General ligament looseness due to medical conditions such as the Ehlers-Danlos syndrome

You may have been treated using special foot inserts or physical therapy, but if other kinds of treatment have not worked, your physician may recommend surgery.

What Causes Ligaments To Become Loose Or Weak?

Having certain foot deformations or ankle sprains can cause your ligaments to start becoming loose and weak. If this occurs, your ankle may become unsteady. LALR is the surgical procedure performed on the outside ligaments of your foot to make them firm again.

Dr. Doerr Orthopedic Surgeon

What are the Risks of Lateral Ankle Ligament Reconstruction?

All surgical procedures involve risks. The risks of LALR include:

  • Ankle joint stiffness
  • Excess bleeding
  • Blood clots
  • Infection
  • Complications from anesthesia
  • Deep vein thrombosis
  • Injury to the superficial nerve
    • This nerve is usually in the wound. It is always identified, but it often is not cut. However, during the surgery and in the healing process, it can become scarred, and this may lead to a painful burning sensation in this area or decreased sensation at the top of the foot. If this kind of neuritis occurs, you need aggressive therapy to desensitize this area as needed.
  • Stretching out of the repair
    • The repaired ligament is usually strong and makes the ankle stable. But it is not restored to its original strength. Thus, further ankle sprains can stretch this ligament again.
  • Lack of progress in your ankle stability

The risk of complication depends on several factors that include your general health, age, and the structure of your foot. Thus, it is essential to consult your physician about any concerns you may have and talk about the risks that concern you.

How Do I Prepare For Lateral Ankle Ligament Reconstruction?

Your doctor will tell you precisely how to prepare for this surgery depending on your overall health and other factors. He or she may ask you to stop taking certain medications such as blood thinners. If you are a smoker, try quitting before surgery. Inform your doctor about all your current medications, including over-the-counter drugs such as aspirin. You will also need to tell the doctor about any shifts in your general health such as recent fevers, illness, etc.

Before the surgery, you may need to take imaging tests such as MRI or X-rays. Also, avoid eating any food after midnight of the night before your surgery. Again, you may have to make some alterations to your activities and home before surgery because you will be unable to stand on your foot for a while.

What are the Types of Lateral Ankle Ligament Reconstruction Techniques?

LALR is done under general anesthesia, and can be done using two techniques:

  • Brostom-Gould technique — often used for athletes who have experienced several years of hyperextension and ankle instability
  • Tendon Reconstruction

Both methods begin with a small incision along the outer part of the ankle. The Brostom-Gould method fastens the ankle ligaments using anchors and stitches fixed into the fibula bone. During the reconstruction, ligaments are replaced by tendons by holding the tendon (either from your hamstring or a cadaver) in place using stitches, or occasionally a screw in the bone.

What Are The Chances Of Complications After Lateral Ankle Ligament Reconstruction?

After LALR, patients often experience decreased sensitivity around the incision area, and sometimes this feeling extends to the top of your foot. This happens in about 20 percent of the surgeries.

Dr. Doerr Orthopedic Surgeon

What Happens After Lateral Ankle Ligament Reconstruction?

After surgery, a nurse will observe you for several hours. Since this is an outpatient procedure, you will not be admitted at the hospital after surgery. You will feel some pain after treatment, and your doctor will administer some pain relievers for the pain. The doctor will also give you advice on how to take your medications and how to care for your wound. The doctor will apply a splint until the swelling subsides, and after a few days, he or she will apply a cast for about four weeks. Then it will take four to six weeks before you can place your weight on the ankle. Sometimes your surgeon will advise you to wear a removable walking boot to help you heal better. The surgeon will also instruct you on how to strengthen the leg and ankle muscles as you recover, and may give you physical therapy as well.

Lateral ankle ligament reconstruction is done on an outpatient basis to strengthen the outer ligaments of the ankle. It is administered after all other treatment methods have been shown to be ineffective. This surgery has potential risks, but its benefits far outweigh its risks. If you have experienced numerous ankle sprains that do not respond to conventional treatments, consult a qualified physician to discuss your eligibility for surgery.

Orthopedic Specialists

Jeffrey Hessing, MD and Timothy Doerr, MD have a passion for helping others. They have a combined 50 years of orthopedic excellence dedicated to the people of the Boise area. All of our surgeons are board certified by the American Board of Orthopaedic Surgery.

Dr. Doerr

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