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Old 08-16-2009, 07:33 PM   #1
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Complete tear of ATFL and CFL

Hi,
I recently had a severe ankle sprain after a soccer game (1.5 weeks ago) An MRI has revealed complete tears of the anterior talofibular ligament and the calcaneofibular ligament.

My doctor has suggested surgery to repair the torn ligaments, and i have two other opinions lined up. I'm 33 and lead a very active lifestyle.

From what i've learned, the surgical procedure that sutures the ruptured ligaments has a 85-95% success rate. My questions are, what kind of complications arise in the remaining percentage? Also what are your opinions on having the surgery or not... thank you in advance

Anxiously yours.

 
Old 08-17-2009, 03:39 AM   #2
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Re: Complete tear of ATFL and CFL

Hi there,
I had a severe sprain, very similar to yours in 2006 from a bad landing while sparring in karate.
I was told by the first dr. who saw me that it was "just a sprain" and had bad after care for the first month to 6 weeks. I walked on it, or tried, and competed in karate 3 weeks later, injuring it again. That may or may not contribute to the outcome of my story here...

So I had a Brostrom repair which is probably what you would have done. I also had peroneal brevis tear and peroneal tendon subluxation issues. In surgery they found I also had 2 OCD spots. From my reading, one probably was there before and the other probably happened at the time of the sprain.

Anyway, I had the surgery to repair everything and already, just 3 mos post injury, I already had traumatic arthritis starting to set in and lots of scar tissue. But, I did well after surgery for a good year and a half. I went back to karate, doing everything I did before. I also got back to running. I considered the surgery a sucess and in most people's cases, that would have been the end of it.

Then at about the 1.5 yr mark I had a few rolling of my ankle. Nothing major, but it rolled. I had an injury or 2 also, minor. I started having more OCD pain and ended up seeing my dr. I have hypermobility in my joints and the simple Brostrom stretched back out. My OCD issues were my major pain cause though. If it weren't for that, I'd probably never had the Brostrom redone.

In Sept. 2008, I had another Brostrom plus some funky anatomical reconstruction that I haven't heard anyone else have where my dr. used a sheath of tissue from my fibula to make new ligaments. I had peroneal issues again, 2 tears this time, microfracture on 1 OCD and OATS procedure on another (don't worry about the OCD stuff, not related really to sprains all the time.) The 2nd Brostrom/fibular sheath worked GREAT. My leg was stable. But, the tendon issues continued due to scar tissue, and my OCD from the sprain still was horrible.

So in July I had surgery #3. - But, no ligament issues at all that needed to be addressed.

I say all this because I had complications from scar tissue and other things they found, but really, the Brostrom was good and if I didn't have hypermobility, the 1st one would have been perfect. The surgery isn't too painful and recovery is somewhat long to get back into sports, but so worth it.

Not fixing your torn ligaments can cause other problems like the OCD I had... My dr. said if I didn't fix my ligament issue then the OCD would never heal right. It's be like your ankle clunking around and your bones getting damaged. You don't want that...ever.
So if you can get it fixed, do it. You want to try and keep traumatic arthritis, OCD's, and scar tissue away. I think if I had better care in the beginning, my outcome with some of this may have been different.

I would get the surgery in a heartbeat. In fact, my other ankle is very unstable as well. I never had the same traumatic injury that my left one did, but I am considering having the ligaments fixed to PREVENT the trouble I'm having with my left. My left ankle is so messed up that my dr. admitted I will never be without pain. My right one wobbles a lot and it hurts more and more, but I want to fix it before I have some major blow out of it.

So, I hope that helps. I know it is a lot of rambling. I have so many issues with my ankle that it is hard to look at one issue, like the ligaments without having to realize there is a bigger picture, but the ligament repair has been the easiest fix with my ankle and the one thing that was the easiest thing to recover from as well.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
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Old 08-18-2009, 10:20 AM   #3
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Re: Complete tear of ATFL and CFL

A quick update.

I saw other doctors after the first one for second opinions. Both other doctors told me that under no circumstances should i be considering surgery for an acute sprain, even one with torn ligaments. Ligaments should heal on their own with proper PT. So i have a brighter outlook than previously

thx again!!!h

 
Old 08-18-2009, 10:32 AM   #4
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Re: Complete tear of ATFL and CFL

Just be sure to go back if you have problems with instability. They are right, you don't do surgery right after a sprain. Mine wouldnt' even talk about it until 3 mos after. But at that point it was obvious that it wasn't getting better and an MRI confirmed torn tendons which are a reason for surgery.
Good luck. I hope your ankle heals well.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 08-18-2009, 10:45 PM   #5
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Re: Complete tear of ATFL and CFL

Thanks. In my case, MRI confirmed all other ligaments and tendons are intact and normal. This includes the ligaments which keep the tibia and fibula together at the right distance... bones and cartilage in the area also checks out Let's hope for the best during PT.

 
Old 04-14-2010, 07:24 PM   #6
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Re: Complete tear of ATFL and CFL

kris5kids I have a question for you I am 10 weeks post injury I have a completely torn ATF and almost completely torn Cf, and have about 20-30 sprains on both ankles. I am not cleared yet to walk without some sort of bracing. I went today to get a second opinion and they want me to have stress xray and are saying I can benefit from brostrom since I do half marathons and want to do some fulls and have crazy flexibility and instability. Any advice on how to get the doctors to go ahead and do the surgery before June? I am scared to death to take my kids to the beach or anything that might put me in a compromising position.

 
Old 04-15-2010, 04:44 AM   #7
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Re: Complete tear of ATFL and CFL

I typed this big long reply for you last night and then somehow promptly deleted before it posted.

Anyway, I'd go ahead with the Brostrom if they said they would do it. Now 10 weeks out they won't schedule it now, but if you put it on the books at say late May, they might. I'd ask them, if they are willing to do it now then go for it. I would most definately bring up your hypermobility and ask them about doing something in addition to the Brostrom. My dr. did something with a periosteal flap from my fibula and used that to reinforce the Brostrom since my first Brostrom just stretched back out. So far that has held up wonderfully. He was going to use a cadavar tendon to use as my ligaments instead of the periosteal flap deal, but I guess he decided he wouldn't need them if he did the flap thing instead and using the periosteal flap would use my own tissues and not a donor. My first os didn't ask or notice I had hypermobility in my joints. My second OS, the one who has done my last 2 surgeries, picked up on that right away and said he would not do a Brostrom again without something else. My thoughts are they do a Brostrom no matter what and if they think your ligaments aren't that great, then they will use soemthing else as well.

I totally understand the feeling of instability at the beach. When I knew I had to have surgery was when I couldn't chase after my son at the beach or football or soccer fields. I was afraid he would run in front of a car and I wouldn't be able to get to him fast enough because my ankle rolled all the time. It was SO much better after the surgery. Although I have all my other issues still going on, I can say that was there before was gone. I did get back to running and my karate after the Brostrom. It took about 5 mos before I was allowed to do much of anything, but it was worth it.

Good luck and keep me updated.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 05-11-2010, 02:04 AM   #8
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Re: Complete tear of ATFL and CFL

Hi - i have read this thread and have found it really useful as i have a very similar injury, together (at the moment) with a fracture of the talus. I am currently in an air caste for the whole ankle to calm down (6 weeks) and seeing surgeon on Friday. I have sprained my ankle so many times i can't remember anymore - but this was the big one: ATFL and Peroneus Brevis all ruptured, as well as the fracture (does not need surgery). I am a serious trail runner, so this has been devastating. My question really involves the level of mobilty one has after surgery (if this is what I opt for). I have been told that the ankle can be compromised regarding agility and power, both of which are essential for trail running. Any advice from those operated on would be great.

 
Old 05-11-2010, 04:21 AM   #9
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Re: Complete tear of ATFL and CFL

spotfred,

Ugh, your injury doesn't sound good at all. Where/how did you break your talus? Do you know what kind of fracture they called it?

Honestly, the type of talus fracture will be your biggest concern. Peroneal brevis and ligaments can be fixed easily with Brostrom and I had no issues with power (I'm a runner too). Agility I noticed some with sparring in karate, but it was more from fear than actual agility. Mobility was perfectly fine in terms of tightness from the Brostrom (I have other issues restricting it, but my mobility came back about 100% after my first surgery) I wouldn't even think twice about having your peroneal brevis repaired and a Brostrom. You can recover from that and get back to trail running. I would ask a lot of questions, however, about your talus fracture, they type, extent, etc., and what they plan to get that healed 100% as that is what will cause you the most problems in terms of pain and getting back to your running.

I would be concerned that if you didn't get the peroneal tendon repaired and the ligaments repaired, then your talus will never heal correctly. You will keep injuring your ankle without the repair for stabilty.
You are seeing a foot and ankle OS, correct? Don't see a general OS for this.

Good luck and keep me updated after your appt. on Friday. Did you have an MRI? Are you NWB now?
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 05-11-2010, 04:56 AM   #10
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Re: Complete tear of ATFL and CFL

Hi Kris

I have had the MRI. Regarding the talus, quote from the MRI/surgeon report "medial osteochrondral bruise (fracture) invloving medial gutter and distal tibial plafond as well as talus itself....right across the talar neck."
I am actually not that worried about the talus as I know that will heal over time - no weight bearing at all at the moment etc (at least no running for 6 months etc.) It's the weak ligaments and tendon I am worried about, and am concerned that rehab just won't make it strong enough.
I did all this damage while trail running, a massive roll over my ankle from a height of about a metre(eversion - apparently this normally happens with an inversion...? - but I have always injured my ankle rolling outwards i.e. laterally) . As I said before, my ankle has been weak for years, with many sprains - this just went all the way.
I am seeing an ankle surgeon so feel like I am in the right hands. What is NWB?
Thanks.

 
Old 05-11-2010, 06:13 AM   #11
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Re: Complete tear of ATFL and CFL

NWB= Non-Weight bearing.

It sounds like your fracture is an OCD (look up osteochondral defect, osteochondral lesion talus, talar dome fracture). But, I wonder what the "Right across the talus neck" is referring to. If there is an actual bone fracture across the talus neck, then you are talking something totally different. I'd get clarification on that one. Anyway, I don't want to scare you, but depending on how much/involved of the osteochondral fracture you have, it could be your biggest pain down the road. See what your OS says about it.

I did almost the same thing as you. I was in karate and landed on it from the air. Same as you, I sprained my ankle a zillion times before. I, however, was not given a aircast or anything by the first dr. I saw, but was told it was "just a sprain" so I continued to compete for 3 weeks until I saw an ankle surgeon who put me on crutches. Anyway, I ruptured my atfl, tore my peroneal brevis, dislocated the peroneal tendons and had the talus fracture as you described (OCD-actually 2 of them).

Take what your dr. says very seriously. I didn't at first. I'm now facing my 4th surgery in 4 years. The talus is what has caused me the most issues. I ran too early, went back to karate too early, and I was not given proper treatment by the first OS I saw. I had the Brostrom surgery and peroneal tendon repairs and microfracture on my ocds(talus) and did okay for awhile. Brostrom repair was the best and easiest to recover from. I wouldn't even think twice about having it done if they recommend it. It won't mess up your ability to trail run. Without getting the Brostrom done, your talus will not be able to recover as well because it will just "clunk around" as my dr. put it. If the ankle is unstable, which yours obviously will be without the ATFL or the peroneal brevis intact, your talus will just be bruised over and over again.

I'm very curious about how your appt. goes on Friday, esp since your injury is so much like mine was. Oh, rehab won't make it strong enough without the surgery. But, after the Brostrom and peroneal repair, rehab will make it strong again. It will take upwards of a year though. Glad you are seeing an ankle surgeon.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
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