Ankle sprains are not just common; they’re a leading reason for visits to emergency departments and specialized clinics. When it comes to these injuries, knowledge and proper care are key to a swift recovery. This guide delves into the nuances of lateral ankle stabilization surgery, offering insights into when it’s needed, what it entails, and the recovery process.
The Anatomy of Ankle Sprains
- Understanding Lateral Ankle Sprains: These occur when the foot twists inward, stressing the ligaments that stabilize the ankle. The anterior talofibular ligament (ATFL) is often the most affected. There are 2 other ligaments on the outer part of the ankle and there called the calcaneofibular ligament and the posterior talofibular ligament. The posterior talofibular ligament is rarely injured with a lateral ankle sprain. The anterior talofibular ligament runs from the side of the talus to the front edge of the lower ankle bone called the fibula.
- Grading the Severity: Ankle sprains are categorized into three grades, from the mild discomfort of Grade 1 to the severe damage and potential ligament rupture of Grade 3. As the grade of injury increases so does injury severity and the amount of swelling/edema, bruising, pain and recovery time will increase as well. More severe sprains are also more likely to progress to something known as chronic lateral ankle instability. Chronic lateral ankle stability is a condition which there is instability of the ankle that leads to further sprains, injury, pain, swelling and difficulty with return back to baseline activities whether this means activities of daily living or more athletic activities.
Initial Treatment and Recovery
- Conservative Care Strategies: Regardless of the sprain’s grade, initial treatment usually involves a short period of immobilization, followed by physical therapy to maintain range of motion and prevent chronic pain syndromes like chronic regional pain syndrome. For higher grade injuries, it is typically recommended that the patient be immobilized with at least a cam boot. This is typically done for no more than 7 to 10 days. Patient is then transition to a lace up style ankle brace and physical therapy is initiated for approximately 6 to 8 weeks. For higher grade injuries, it normally does take in 6 to 8 weeks for the patient to reintroduce higher impact activities. We strongly believe in the concept of activity modification versus restriction. Higher impact activities should be discouraged through the recovery until cleared by a physical therapist or doctor.
- The Role of Physical Therapy: A structured rehabilitation program is crucial for healing. It helps restore function and can prevent the development of chronic lateral ankle instability.
When Surgery Becomes Necessary
- Identifying the Need for Surgery: Surgery is considered for those with recurrent injuries, persistent instability, or chronic pain, indicating a failure of conservative treatments. Again, this condition is known as chronic lateral ankle instability. It is important to make sure that no other pathologies are present such as an osteochondral lesion of the talus, which is a cartilage injury of the foot bone inside the ankle joint. Sometimes there can also be a sprain to the inner ankle ligament called the deltoid ligament. In most cases, a patient will be undergoing an MRI if they have failed to respond to the typical conservative measures like physical therapy which can help identify other areas of concern that physical examination alone, or x-ray may or may not identify.
- The Modified Broström Procedure: This surgical option involves repairing and reinforcing the damaged ligaments, often supplemented with an internal brace for additional stability.
What is a modified Broström with internal brace?
- Procedure Overview: A modified Broström with internal brace is a surgical procedure to help strengthen the outer ankle ligament called the anterior talofibular ligament. This is the most commonly injured ligament with chronic lateral ankle sprains. Incision is placed on the outer part of the ankle. The ligament, or what remains of it, is exposed and detached completely from the outer fibula bone. Next, 2 anchors are placed into the fibula and sutures are utilized to tighten up the ligament. The internal brace, which is a broader piece of suture is then laid on top of this reconstruction to strengthen the repair. The internal brace for lateral ankle reconstruction has been proven to shorten recovery times, allows patients to get back to full weightbearing sooner and can also allow for return to activity sooner as well.
- Post-Operative Care and Rehabilitation: Typical postop recovery includes at least 2 weeks of nonweightbearing to the ankle that is fixed. 2 weeks allows for the soft tissues to calm down and for the incision to help. Sutures were removed around 2 weeks postop. The patient can then initiate weightbearing with a cam boot in place. Physical therapy is typically started around 3 to 4 weeks postop. Patient can normally return back to regular sneakers around 6 weeks postop. Return to athletic activities can typically be ramped up most patients are back to baseline activities around 3 to 4 months postop. Overall recovery can still be longer and take up to a year. Sometimes additional procedures need to be done at the same time of the Broström which may lengthen the recovery. An example of this would be if the cartilage replacement is required for an identified osteochondral lesion of the talus.
Conclusion
For those suffering from chronic lateral ankle instability, the modified Broström repair with internal brace offers a promising path back to stability and function. While many ankle sprains heal with conservative care, this surgical option stands as a beacon of hope for individuals looking to return to their active lifestyles without the shadow of instability looming over them.