Ankle Ligament Reconstruction

ACCELERATED REHABILITATION PROTOCOLS

Frequent ankle sprains or a feeling of “give-way” often follow a severe ankle sprain. During a sprain, the ankle ligaments are torn. Frequently, more than 50% of the time, they do not heal in the correct position. While many activities are possible without normal functioning ligaments, problems commonly arise. Patients with ankle instability report the inability to play sports requiring sharp turns, and note that their ankle “rolls” when walking on uneven ground. In some cases, a chronic ache in the ankle develops. When left unaddressed ankle arthritis and peroneal tendon tearing are common long term problems. Often, ankle strengthening exercises and bracing are ineffective in permanently relieving the pain. This surgery is recommended when the ankle is mechanically unstable. It is performed on an outpatient basis. The latest advances in surgical technique combined with a proven, and more aggressive post-operative rehabilitation has made recovery much easier and safer.

Pre-operative Care

Ankle Ligament Surgery

The surgical center will inform you when to arrive and how to prepare for surgery. Get ready for your recovery by reading Dr. Silverman’s tips for preparing for surgery.

The day of surgery you will receive regional anesthesia known as a Popliteal nerve block. This is a procedure performed by the anesthesiologist prior to surgery. You will be given medication to induce “twilight sleep”, placed on your stomach, and a small needle will be used to inject Novocain-like medication around the nerve in the back of your leg. It gives complete pain relief that lasts for 12 to 36 hours after surgery. Patients report extraordinary satisfaction with this type of anesthesia

Operative Care

During the surgery you will be put into a relaxed state by the medication delivered through the I.V. A tourniquet will be placed around your calf. You will not feel the pressure because of the nerve block. Ankle arthroscopy is performed if a concern of early arthritis exists. Two small (¼ inch) incisions are made on the front of the ankle. Occasionally, a posterior incision is made. The ankle joint is inspected and treated as necessary. A small incision is made along the lateral side of your ankle. The ligaments are tightened using sutures. This procedure is commonly known as the Brostrom-Gould anatomic ligament reconstruction. It respects normal anatomy and recreates a normalized ankle tension and stability. The wounds are closed with stitches. The leg is placed into a split cast with the foot carefully positioned to protect the ligament repair.

Immediate Post-Operative Care

Once your anesthesiologist is satisfied that you have recovered you will be permitted to leave the surgical center. During this recovery time your family member may take your prescription to the nearest pharmacy. You will need to purchase crutches as well. After you get home, get your leg elevated and take advantage of the pre-operative planning you did. Follow Dr. Silverman’s Post-operative Instructions. Take your narcotic pain control medications before falling asleep or as you feel the “numbing” effect wear off. Remember, post operative pain is much easier to control with prevention. Schedule your post-operative visit for 2-3 weeks after surgery when you are able.

To schedule surgery, please contact us at info@anklefootmd.com or 952-224-8500 at least four weeks in advance to best ensure your desired surgery date. If you have questions after surgery, please contact my office.

Post-Operative Course Ankle Ligament Reconstruction

This timeline is a general guideline. Your post-operative course may vary.

Dressing – After 4 weeks apply an ankle brace. Wean off of the brace in several months through with physical therapy. Expect to use it for athletics for the next 6 months

Elevation 23 hours / day for 3 days; then keep elevated as needed. Swelling may last over 4 months.
Motion Move your toes and knee when the block resolves. This will decrease pain and swelling, and improve healing. Begin ankle motion at 4 weeks.
Walking No weight bearing until 3 days, Weight bearing is as tolerated in the cast and/or boot afterwards.
Bathing Keep cast dry by using a Drypro. You may order this from the online doctor store. There are no restrictions after the cast is removed.
Pain Control Use the strong extended and rapid acting narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Motrin.
Work Return depends on specific demands. It is safe to return to sedentary work at 5-10 days post-op. Return to heavy labor will take over 2 months.
Driving Patients undergoing left foot surgery may drive an automatic transmission. Patients undergoing right foot surgery need to drive with their left foot until they feel safe to resume.

Accelerated Rehabilitation for Reconstruction of Torn Ankle Ligaments

2-3 weeks Remove cast and apply cast boot. With more significant swelling expect a prescription for a Bioskin Aftercare compression brace.
3 months Return if you have pain, other concerns, or per Dr.Silverman’s instructions. Minimal feelings of discomfort may linger, your overall comfort level improves over a year.
********** If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, you should contact our office.

Visit our video center to watch rehab exercise videos that will help you recover after your surgery.