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Old 05-01-2010, 05:15 PM   #1
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MRI says ATFL is missing after a bad sprain???

Hi, I am new to the message boards. I sprained my ankle on December 6, 2009 and was told to use the RICE method to get it to heal. 5 months later I am still have pain, stiffness, etc. so OS ordered the MRI. MRI finding were the the ATFL is missing, consistent with a sprain. I am assuming that I have ruptured the ligament. Had a cortisone shot and he is sending me for a second opinion which is in two weeks. Anybody, have a clue if I am going to need surgery to replace the ATFL and what the heck happened to it (the missing part)????! My research on the internet says the Bromstron procedure which sounds painful and LONG.
Any feedback would be helpful!

 
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Old 05-02-2010, 06:22 AM   #2
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Re: MRI says ATFL is missing after a bad sprain???

My ATLF was not found on my 1st MRI after my injury either. And yes, I needed a Brostrom. It didn't vaporize, but probably ruptured. The Brostrom isn't that bad really. A long rehab, but pain isn't outragous. They'll just sew the 2 pieces of the ligament together to make it shorter and tighter. They'll most likely do the other ones on that side as well.
Make sure you get a foot and ankle specialist to do this and not a general OS.

If you have any questions let me know. I've been through Brostrom twice, although the 2nd one I had additional reinforcements made. But don't worry about that, my body is just stretchy. You will notice the Brostrom will help SO much.
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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 05-02-2010, 06:31 AM   #3
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Re: MRI says ATFL is missing after a bad sprain???

Thank you for your reply! I am trying to do my homework first before I see the surgeon. I guess what I am wondering if the MRI report says that the ATFL is missing then will they need to graph it with something else? My stability seems to be ok however, I am very cautious for fear of re-injuring it. A doctor friend of mine said that unless I plan on becoming a runner I can get along with just ligaments because the surgery is intensive. Of course, reading about how long the recovery is and the time to be immobile I would like to avoid the surgery if at all possible!
Did your surgeon give you any other options other than the surgery?

 
Old 05-02-2010, 06:54 AM   #4
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Re: MRI says ATFL is missing after a bad sprain???

They won't have to graph it with something else. It is there, just not in one piece. They'll often reinforce with something called a retinaculum (spelled wrong, I"m sure). They'll sew the ends together. Mine was also not there on the MRI and they did sew it back together. It's like a piece of elastic that got cut in half. They'll take the two ends, overlap them some and then sew them together.

For me, I didn't get any other options other than I could not do it, but I also had a peroneal tendon tears, subluxation of the peroneal tendons and I found out at surgery 2 OCD lesions. My joints are hypermobile and so my ankle was so unstable that it rolled all the time, like many times each day. I'm a runner and was at the time competing nationally in karate, so I had no choice in my mind. I couldn't get through a competition without spraining it again.

My second Brostrom I did have reinforced, but only because I stretched out my first one with no injury to it. I did have great relief from the instabilty after the Brostroms and I would do it. Rupturing your ATFL could cause more issues down the road if you keep spraining it now. You don't want to go there. If you are not in pain and you do feel stable, you could wait. I just couldn't function and I was in a lot of pain (from the OCD's it turns out, not as much the ligaments) and so I went along with the surgery.

Alot really depends on how active you are. The Brostrom really is the standard procedure for repairing ligaments and instability. It isn't that bad of a procedure. The recovery for any ankle surgery, really is long. Of the things I've had done to my ankle (I'm working on my 4th ankle surgery in June) the Brostrom was the one thing that worked the best and had the easiest rehab. So I wouldn't be worried about that. It'll be 5 mos before you can run again. At 4 months out you will feel pretty good. The pain isn't bad when you are NWB, but between weeks 10-16 it is a bit rough, with week 16 being the last of the pain. 10-14 are the worst.

I guess it has to do with your pain level. You can always do it later down the road too.
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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 05-02-2010, 03:47 PM   #5
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Re: MRI says ATFL is missing after a bad sprain???

Thanks Kris! I will see what he says in two weeks!

 
Old 05-08-2010, 06:26 PM   #6
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Re: MRI says ATFL is missing after a bad sprain???

Kris,
I was wondering what OCD's are?

 
Old 05-09-2010, 06:49 AM   #7
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Re: MRI says ATFL is missing after a bad sprain???

Kris can you explain what an OCD lesion is. They sound very painful and it seems like lots of people on here have them. Thanks.

 
Old 05-09-2010, 09:54 PM   #8
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Re: MRI says ATFL is missing after a bad sprain???

Sorry,

I've been sick and busy and busy being sick.

OCD, OLT, osteochondral fractures, osteochondral defects, talar dome fractures, are all names for the same thing.

I've heard it described this way best... Think of the talus as an apple. Now imagine it getting bruised and dented in. At first, the cartilage or skin of the apple is okay, but the underlying surface is damaged. Eventually, the skin of the apple (or in the ankle's case, the cartilage on the talus) can break away or at minimum be pushed in when the underlying bone has started to die or has failed to heal. SOmetimes the bone is slightly bruised and can heal on its own, other times the cartilage and underlying bone can all break away. Imagine the apple with the skin gone in parts and the flesh dented in. Now think if your joint surface was like that. Not fun. So there are many levels of OCD's from just bruised a bit but still intact to a big chuck is out of there.

There is a ton of info out there to explain it better if you do a search. Most people just say OCD, although I think the term being used more lately is OLT or Osteochondral Lesion Talus.
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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 08-21-2010, 03:10 PM   #9
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Re: MRI says ATFL is missing after a bad sprain???

Hello, I have had the Brostrom Procedure done on May 13, and I am already done utilizing the Aircast boot you get till you can walk on your foot. Seriously the worst part of the pain was the first three days after surgery. It is now August 21, and I am 2.5 weeks into physiotherapy, I am doing strengthening exercises, walking with an air sports brace. For exercise I am limited to stationary bike and water running. For the bike exercise the pt told me to drop the height of the seat 1 inch per week and I cycle 4x a week. This works on the amount of movement through the cycle and raises your knees to your chest and puts more force on the ankle bending up and down. The best thing for the swelling is to use a hot and cold bucket. I use a 5 gallon pale and I put ice cold water 12-15 degrees celsius, and hot water is at 38 degree celsius.

 
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