Ankle Arthroscopy & Lateral Ligament Reconstruction

Ankle arthroscopy and lateral ligament reconstruction is required for ankles that remain unstable despite appropriate physiotherapy. The surgery involves removing any loose cartilage and/or scar tissue from the ankle by arthroscopy (key hole surgery), and repairing the torn ligaments (anterior talo-fibular and calcaneo-fibular ligaments). The ligaments are attached to the fibula bone using two small suture anchors (screws).

Ankle arthroscopy and lateral ligament surgery involves a number of steps. These include:

• General anaesthetic, antibiotics
• Two small incisions (each 1 cm long) over the front of the ankle
• Insertion of arthroscope
• Insertion of arthroscopic equipment including scissors, scrappers, shaver and burr
• Incision over outside of ankle (5 cm long)
• Reconstruction of the lateral ligament with two suture anchors (small screws) inserted into fibula bone
• Wound closure with stitches/sutures
• Infiltration with local anaesthetic
• Back slab plaster

All surgical procedures carry some risk. The risk of complications with ankle arthroscopy and lateral ligament surgery is low. Some of the risks of surgery include:

• Infection
• Nerve injury – this may result in numbness, tingling and/or pins and needles on the top of the foot
• Deep venous thrombosis/pulmonary embolism (the risk of DVT increases with smoking, the oral contraceptive pill and hormone replacement therapy, immobility and obesity)
• Anaesthetic complications
• Drug allergy
• Post operative synovitis (inflammation of the lining of the joint), this usually settles with anti-inflammatory medications
• Ongoing pain
• Ongoing instability

Rest

• You will have a cast on your leg. Keep foot elevated as much as possible, especially for initial 72 hours. Keep dressings dry and intact until post operative appointment.
• Mobilise short distances as pain allows, aim to remain in your own home for the first few weeks limiting long periods of standing or mobilising
• Do not bear weight for the first six weeks

Pain

• Pain relief may be required for up to 2 weeks; depending on your other medications this may include:
• Regular paracetamol, anti-inflammatory drugs and break through opiate type medications
• A regular blood thinning medication will also be prescribed for 6 weeks

Driving

• Any surgery performed on the right foot or both feet will mean no driving for a minimum of 6 weeks
• If surgery was performed on the left foot then driving in an automatic is possible, but Dr Phegan would recommend waiting a minimum of two weeks before attempting to drive

Driving any vehicle with a cast or boot is potentially hazardous and you should consider this before getting behind the wheel.

Follow up

• Keep all dressings dry and intact for the first two weeks
• Removal of stitches/sutures typically occurs at an appointment with Dr Phegan and his in-house therapists at 10-14 days at first post operative appointment. Very occasionally some sutures need to stay in for longer
• Your appointment will be booked by Dr Phegan and a confirmatory SMS will be sent informing you of the time and date for follow up

Typical milestones

• 2 weeks: Wound review and removal of sutures, change from cast to boot, commence some early active motion. Touch weight bear in the boot
• 2-6 weeks: regular physiotherapy to increase range, gradually increase load to 100% by six weeks
• 6 weeks to 3 months: commence rehabilitation with strength, range of motion and proprioceptive exercises
• Full recovery 3-6 months

Every patient's recovery is individual and depends on the severity of the injury and the complexity of the surgery.