Ankle Ligament Reconstruction - Foot Problems Message Board

LisaUT · 01-18-2005, 04:08 PM

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!

Bigdog Two · 01-18-2005, 08:00 PM

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.

LisaUT · 01-19-2005, 07:07 AM

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!

Bigdog Two · 01-19-2005, 08:57 AM

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.

LisaUT · 01-19-2005, 11:53 AM

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!