Ankle ligament reconstruction surgery

Ankle ligament reconstruction surgery is usually carried out to treat sprains and instability.

What does it involve?

This type of surgery is usually carried out as a day case procedure where you will be given a general anaesthetic along with an injection around the ankle so that it’s numb and pain-free after surgery.

In some cases, the surgeon will first carry out ankle arthroscopy to inspect the joint before repairing the ligament. The procedure itself involves one incision (cut) on the outside of the ankle to allow the surgeon to locate the scar tissue from the torn ligament near the fibula bone, and carry out a repair with stitches to the bone.

Recovery

Immediately after surgery:

• Your foot will be in a plaster cast below the knee, numb and pain free
• You will be sent home only once you are comfortable, when you will be given a follow-up appointment and painkillers if required
• You will be referred to a physiotherapist who will advise on a rehabilitation programme and help you to walk, without taking your full weight at first

During the first few weeks:

• Elevate your foot (raise it above the level of your heart) as much as possible to reduce swelling
• Move around only when you need to, for example to wash or use the toilet. Don’t put weight on the operated leg
• Some blood ooze can be expected. However, if you are worried, contact the Fortius Clinic for advice
• Your doctor may suggest that you take anti-inflammatory medication for around six weeks after surgery
   

Follow-up appointments:

Everyone is different, so healing and post-operative programmes vary from person to person. However, the schedule of follow-up appointments below is typical:

• Two weeks - your wound will be checked and you will be fitted with a new boot
• Six weeks - your boot will be removed and you will be able to wear normal shoes
• 12 weeks - final appointment and discharge
   

When can I start to walk?

This will depend on the type of procedure you have had, and you may be offered a type of boot or brace to keep your ankle still while it heals. However, the appointments below are a guide to your visit schedule:

• 0-2 weeks - you will have a plaster cast and be non weight bearing with crutches
• 2-4 weeks - you will be given a boot to immobilise your foot and be partially weight bearing with crutches
• 4-6 weeks - you will still use the boot but can fully weight bear at around six weeks, when you may be able to wear your usual shoes
   

Physiotherapy and rehabilitation

Your specialist will be able to refer you to a physiotherapist who can give you a personalised rehabilitation programme to help you to walk normally and reduce swelling and tightness in the muscles.

How do I wash and shower?

It’s important to keep the plaster cast totally dry. However, you will be able to shower with a waterproof cover over the plaster or boot. Once the plaster is removed you can shower as normal if the wound is healed, but gently dab it dry. Take extra care of the ankle when you are not wearing the boot to avoid further injuries.

How can I look after the incision wound?

Once out of cast, don’t pull at scabs but let them fall away naturally. If your wound becomes red, swollen or sore you should contact the Fortius Clinic and arrange to see your consultant to check you don’t have an infection.

When can I start to drive again?

The DVLA states that it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car during an emergency stop. This will normally take at least six weeks.

Although your specialist will advise you about when it’s safe to start driving again, it remains your responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.

When can I return to work?

This depends on the type of work you do and how quickly you recover. As a general guide, if your job involves sitting down for most of the time you should be able to return to work after two weeks; if it involves manual work, you may need to have between eight and 10 weeks off.

What long-term outcome can I expect after surgery?

Once the wound has healed, and provided that you follow your rehabilitation programme (which can take around three months), most people are able to return to a good level of activity and sports within four to six months, with continued improvement for up to a year. In 95% of people, ligament reconstructions are extremely successful, although you may have mild swelling in your ankle for up to a year after the procedure.

What are the risks?

Below is a guide to the risks of this type of surgery. However, your surgeon will discuss these with you before your procedure, and answer any questions you may have:

• Infection
• The chance of infection is around 1% and can usually be treated with antibiotics
• Nerve damage
• Small nerves that supply feeling to the skin near the operation site can be damaged, although the risk is very small (around 5%). If your toe stays numb after surgery, the nerve may be bruised but will usually recover
• Further instability
• The risk of having further ankle instability following this procedure is low (around 5%) and further rehabilitation goals can be set with physiotherapy. However, if necessary, further surgery can be carried out
• Deep Vein Thrombosis (DVT)
• You may be given blood-thinning medication after the surgery if you are at a higher risk of DVT (where a blood clot forms in a deep vein in the leg). However, the risk of DVT after this procedure is less than 3% and may be reduced if you keep your ankle moving and carry out the recommended exercises

Important: This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery