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Foot & Ankle Problems Message Board
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Old 02-18-2012, 01:58 PM   #1
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Should I go ahead with synovectomy, ATFL and CFL reconstruction?

Hi,

firstly great forum

I injured my ankle 12 months ago resulting in complete tear of ATFL and partial tear in the fibular attachment of the CFL. There was also suspicion of an un-displaced distal fibular fracture.

The orthopaedic surgeon has tried conservative management with a lot of physio and also provision of mild orthotics. Before physio I could manage 2cm on the knee-to-wall test, now I have 15cm which is full range apparently.

However, the ankle joint is getting aches after walking for a few blocks, feels unstable on uneven ground even with lace up safety work boots (unless I wear a lace up rigid brace inside them) and will lock up if I crouch down probably 40-50% of the time. Usually if I stand back up then crouch again the joint will move further. The physio has now given up on me as he said that is all he can achieve and suspected arthritic changes in the ankle.

After telling the surgeon about this at the last checkup, he ordered another MRI which showed inflammation in the synovium (below) which he said would be more like coral rather than a smooth slippery surface. He has tried steroid injections into the joint once about 9 months ago but it had little effect. He doesn't like to do them more than once due to potential joint damage although he said some ortho's will do it up to 3 times.


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have not been doing any sport or anything since the injury, so it has got this way by just doing day to day activities.

He has asked me to consider a reconstruction of the ligaments (he didn't specify technique) and partial synovectomy to repair the ankle. He said that there would be 6 weeks NWB, plenty of physio again and I should be fully recovered in 6 months.

Now the question is, should I go though with the surgery? At the moment these are my thoughts:

Pro Surgery - if I already have synovitis in only 12 months (not even jogging or playing sport), what is my ankle going to be like in 40 years?

Against - long recovery (I have 2 kids under 3 years to help look after as well)
- risk of it getting worse if surgery goes bad
- more painful physio!
- the ankle seems OK for office work as it is (just aches a bit at the end of the day)

If anyone has had this surgery can you let me know your thoughts?

thanks

 
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