If your ankle keeps rolling, giving way or twisting, it might be because of a long term weakness in the ligaments on the outside of the ankle. You might have had a recent severe sprain, it might have happened many years in the past or you may never remember any injury to the ankle. You may feel you have lost confidence in the ankle, in particular when walking on uneven ground. You may have pain and swelling on the outer aspect of the ankle.
For some people a good course of physiotherapy and a use of a supporting brace will control the symptoms.
If you are thinking of surgery, you would have a MRI scan to look for other problems in the ankle such as peroneal tendon tears (tears of the tendons on the outside of the ankle which can be repaired as part of the same operation) or osteochondral lesions – chips in the joint surface which can be treated with keyhole (arthroscopic) surgery.
If your ankle has been unstable for over a year and has not improved with physiotherapy and bracing it is unlikely to do so. This leads to a risk of the ankle continuing to roll and give way. In the long term this can lead to osteochondral lesions or to development of arthritis in the ankle.
Surgery is usually carried out under general anaesthetic and you would usually either go home the same day or stay one night. You will meet the anaesthetist before the procedure to discuss what type of anaesthetic is best in your situation.
Many operations have been described for repairing the ligaments. Contemporary surgery for most people involves reattaching the ligaments securely back to the fibula (the strut bone on the outside of the ankle) using strong anchors in the bone. This is known as a Brostrom – Gould reconstruction.
The surgery is usually done through a small J-shaped incision along the lower end of the fibula. The scar heals well in this area for most people.
The reconstruction can be strengthened by use of an “Internal Brace” device which strengthens the repair and accelerates the recovery. The internal brace is a strong synthetic cord attached along the natural line of the ligament. Use of this brace allows you to bear weight straight away after the operation so removes the need for crutches.
You will wake up with bandaging on your ankle. In some situations you might have a temporary cast – most people having the internal brace will not need this and will have a removable Moonboot (a Velcro strapped boot) for the first three weeks.
You can walk straight away. At first it will be shorter distances building up rapidly over the first two weeks. You will have an appointment around two weeks after surgery to check the wounds. The stitches are usually dissolvable so do not need to be removed. When you come out of the boot you will have a course of physiotherapy and can return to driving.
All surgery carries some risks. Ankle stabilisation is generally a very successful operation, working well in 95% of people. The risks are rare but include:
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