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Old 01-18-2005, 04:08 PM   #1
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Ankle Ligament Reconstruction

Hi! New here! Back in 1998 I broke my ankle in 2 places playing softball... I ended up with a plate and 5 screws. Somewhere between then and now I had the plate and 4 screws taken out, however I still have one screw left for stability. In October I noticed that my ankle has been hurting, it swells, and I roll it alot. I fell carrying my 4 yr old an decided it was time to go back to the dr. He said that I have torn my ligament and it was instable. He recommened therapy and then surgery in March. My insurance will only cover so much therapy so we decided to do surgery now and therapy after. They are going to reconstruct the ligament, something about wrapping it back around the bone and attatching it to the tendon and removing the screw. I was wondering if anyone has been through this who would like to share info as to what to expect, how much time on crutches, what the pain is like (Im a wuss), how much PT, etc. I dont have my preop appt until Thursday and surgery is on Monday so I would like to prepare as much as possible. Thanks!

 
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Old 01-18-2005, 08:00 PM   #2
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Re: Ankle Ligament Reconstruction

I had a similar procedure 8 weeks ago today (modified Brostrom). No tendon used to reconstruct, instead the ligaments were cut and then reconnected. I was in a cast for six weeks (three of them NWB) and then am in an aircast for four weeks. The pain wasn't too bad for me so long as I kept it elevated most of the day for the first two weeks and so long as I stayed ahead of the pain with the pain meds. I was on two vicodin every three hours. I tapered to one every four hours at about a week and went to OTC pain meds at about 12 - 14 days.

A few bits of advice, which you probably know from your prior surgery:

1. If given the option of staying over night in the hospital, do it.
2. When you get home, set an alarm to wake yourself up at night to give yourself pain meds. Waking up at 2am in agony isn't fun.
3. Take a laxative from the git go.
4. If you don't have an iPod, get one, and quick. Listening to my iPod on the couch and late at night when I couldn't sleep were actually great moments.
5. Go on the net and buy a cast shower cover by "Drycast" and also buy the itch spray called "Castblast"
6. If you haven't seen "Garden State" - I'd recommend it (this has nothing to do with your impending surgery.

 
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Old 01-19-2005, 07:07 AM   #3
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Re: Ankle Ligament Reconstruction

I didnt get alot of info from my dr about the surgery b/c he said we would talk about it after PT... but b/c we changed our course and are going to do surgery first, he referred me to s Sports Medicine Specialist in our area who is very good at this type of surgery. All he mentioned to me was graphting it with the tendon, and wrapping the liagement around the bone or something. I go in tomorrow at noon to my preop and get all my info.

I have a 4 yr old and a 2 yr old, so this will be interesting... Wish me luck!

 
Old 01-19-2005, 08:57 AM   #4
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Re: Ankle Ligament Reconstruction

Lisa:

I am kind of obsessive and did a lot of reading and researching prior to my surgery. There are a number of different surgical techniques to repair ankle ligaments. They surgeries fall into two camps: repairative and reconstructive.

I had a repairative surgery (Modified Brostrom). WIth this surgery the ATFL and CFL (two main lateral ligaments) are cut then reattached shorter to the fibula. The extensor recalcanium (sp?) which is ligament like tissue that holds the ligaments tight to the foot is moved up into the ankle joint and attached to the fibula. This gives greater support. No tendons are used to reconstruct the ankle. With a repair surgery the anatomy basically stays the same - its just tighter. Near full range of motion is acheived in the future and you can go back to an almost normal ankle. Long-term studies show 85% -90% of patients report "excellent" outcomes. In a small number of cases instability and sprains continue and another repair surgery is necessary or often a reconstructive surgery will be done. The Brostrom procedure has a quicker recovery time.

Reconstructive surgery involves harvesting a tendon to tighten the ankle ligaments. The most common is Christman-Snook which harvests (usually) part of the peroneus brevis tendon and wraps it around the fibula and attaches it. No repair of the ligaments is made. The tendon will provide the support. Reconstructive surgery is more invasive - the incision is bigger. Recovery is a bit longer (a few more weeks non-weight bearing, move from a cast/boot is a few weeks longer) and likely is more painful. After recovery the ankle is tighter and a full range of motion cannot be achieved again. There is less chance of further instability or sprains (in return for less range of motion). From what I read and what my OS told me, Christman-Snook is usually used only if (a) the ligaments are too damaged to do a Brostrom, or (b) the patient is in a profession where increased tightness or stability is needed (e.g. football linemen), (c) the patient is heavy, (d) a prior Brostrom failed.

In my case I had an MRI and an arthrscopic debridement prior to my ligament surgery so the OS knew that the ligaments could be repaired. Its difficult to tell from just an examination. My OS said that I had one of the looser ankles he has seen, yet was able to repair the ligaments rather than do a reconstructive procedure. Without an MRI or prior look often the Dr. won't know which type of surgery until they see the ligaments. My OS (who is a foot and ankle specialist) said that he is able to do a Brostrom in the vast majority of cases.

So far (8 weeks after surgery) I am really happy with my surgery. Prior to the surgery it felt as if my ankle just didn't fit together right. It feels much better now. PT is going great. My limp is getting less and less each day. I am swimming, doing light yoga and using the exercise bike. My range of motion is getting close to my left ankle. I am getting pretty excited about returning to normal life. Realize though, especially on top of your prior fracture, that your injured ankle will never be like the other one.

Good luck. Keep us informed.

 
Old 01-19-2005, 11:53 AM   #5
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Re: Ankle Ligament Reconstruction

Good information... I wrote down alot of what you all have said to take with me tomorrow. Anything is better than what I have now. I roll my ankle 1-2x a week, I always been unbalanced, and at night it just throbs. I know it is going to take alot to get to the point that I feel good, but knowing its coming makes it alot easier. Thanks for your info... Ill be around!

 
Old 01-19-2005, 12:10 PM   #6
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Re: Ankle Ligament Reconstruction

Lisa,
Hi, I have not had ankle surgery but have had many aother foot surgeries and I just wanted to wish you luck.I hope your husband is going to take time out to help you. I'm a single mom of 3 kids, 2 of which are living with me(15&10)and it is hard even with the older ones.
Sue

 
Old 01-19-2005, 12:48 PM   #7
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Re: Ankle Ligament Reconstruction

Lisa - I was in a similar boat. My was experiencing "subluxation" multiple times a week - that's where the talus slips out of place and was twisting it about once a month. I was in chronic pain and could not sleep through the night. I was worried that the surgery would not fix the pain. But, it seems that it has. It was totally worth it (so far) and I assume that it will be for you as well.

 
Old 01-19-2005, 01:36 PM   #8
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Re: Ankle Ligament Reconstruction

Bigdog-That is great to hear... I hope for similar results.
Susie- My husband is taking a couple of days off and then will drive me to/from work when I am able to return.

*** Good question, how long did everyone stay off work?

 
Old 01-19-2005, 04:08 PM   #9
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Re: Ankle Ligament Reconstruction

I had my surgery on a Tuesday and went back to work on the following Monday. It was probably a bit too soon - not due to pain but because of the vicodin. I was somewhat loopy, couldn't really focus and spent much of my first two days playing on the internet and forwarding cartoons from explodingdog.com around to my co-workers. They found me entertaining and thought that it was worthwhile that I came to work. I tried to avoid dealing with clients for those few days. I probably should have stayed out of the office until about the 10 day point.

My wife drove me to work everyday (after we dropped my kids off at school) and co-workers gave me a ride home everyday (I work a 1/2 mile from home).

I love to drive and love my car but found that for six weeks it was kinda nice not jumping in the car and running off to various places like the dry cleaners and grocery store etc.

Prior to the surgery I was pretty freaked out - not about the procedure, but about the recovery. Being in a cast for six weeks - not being able to drive or go to the gym - crutches, etc. It felt like someone saying "you will break your leg in 2 weeks" (or whatever). It turned out not to be that bad. Life moved at a slower pace. I spent more time laying around (which I like), reading and listening to my iPod. I really tried to absolutely enjoy each and every day that I basically had "forced relaxation." It will be tough for you with kids, especially being mommy, but hopefully your husband will be able to step up a lot.

 
Old 01-20-2005, 07:02 AM   #10
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Re: Ankle Ligament Reconstruction

I go to my appt today... any thing specifically I should ask him about? This is all new to me, when I had my surgery done before it was on an emergency basis soI didnt have time to think about it.

 
Old 01-20-2005, 07:19 AM   #11
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Re: Ankle Ligament Reconstruction

Questions I found helpful or wished I had asked:

1. What type of anethesia?
2. Will I stay overnight (BTW I would recommend this)?
3. When will I have my follow up appointments? And walk me through the timeline after surgery till recovery is done. How long non-weight bearing; how long in the post surgical cast, how long in other cast(s), how long in a boot, how long in an aircast, how long on prescription pain meds?
4. When will I get stitches out?
5. How bad will the pain be?
6. Can I drive? Can I get a handicap parking permit?
7. How many of these procedures do you do a year?
8. What percentage of the time are there problems/complications? What are those problems? In your experience, are your patients pleased with this procedure?
9. How certain are you that this will fix my problem? What is the long-term prognosis?
10. What exactly are you going to do (describe exactly the procedure)?
11. How long until I can return to running/sports/whatever? How long until I am fully healed?
12. When will I start PT? How often and for how long will I go to PT?
13. Will you give me a pain prescription now so I don't have to fill it after the surgery?
14. What is the largest prime number you can think of off the top of your head?

Hope this is helpful. Make this OS spend the time to answer your questions. They often seem very busy but you deserve to have him/her take an extra five or 10 minutes and make sure you know what to expect.

 
Old 01-20-2005, 04:44 PM   #12
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Re: Ankle Ligament Reconstruction

Speaking of ligament reconstruction...does anyone have any advice for taking care of your incision so that it heals quickly and beautifully? I had a Brostrom on 12/28; I am still NWB (until 2/4) but I am fortunate enough to have a boot that I can take off for showering, which allows me to keep the incision nice and clean. Any advice would be fantastic!

 
Old 01-20-2005, 04:54 PM   #13
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LisaUT HB User
Re: Ankle Ligament Reconstruction

I am back from the dr... he said that he isnt going to remove the screw... he feels that the other OS didnt b/c the head was stripped and if he was to remove it, it would be a seperate insicision and just not a good choice. He said the screw isnt hurting anything so not worth it. He is going to go with the Brostrom (sp) procedure. He isnt going to put a cast on it, but a splint for 10 days and then a walking boot after that. He isnt expecting crutches for more than about 2 wks... but said he will see how I am doing at my postop appt.

 
Old 01-20-2005, 05:58 PM   #14
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Re: Ankle Ligament Reconstruction

Things are rough right now..I have the stomach flu. So running fevers and getting sick when its hard to get around already (crutches) is not fun at all...wonderful.....[/QUOTE]

I know the feeling. I have the flu also... I feel crappy. I am glad to have it now before crutches... sorry you arent feeling well ::hugs::

 
Old 01-20-2005, 05:59 PM   #15
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Re: Ankle Ligament Reconstruction

Where are your incisions/scars at? I already have one up the side and he said that he is going to leave that one alone.. that he does it below the ball part on the outside. I have been doing some research online and have seen a couple of pictures, but nothing that specifically is my surgery so Iw as just curious.

 
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