Ankle Ligament Reconstruction: Chronic Ankle Instability Treatment

Lateral Ankle Ligaments

There are 3 ligaments on the outside of the ankle that commonly get injured or torn in an ankle sprain – namely the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL) and the calcaneofibular ligament (CFL). Repeated injuries results in chronic ankle instability.

Lateral Ankle Ligament Reconstruction for Chronic Ankle Instability

In severe or recurring cases of ankle sprains or chronic ankle instability that is refractory to conservative treatment, surgical repair and reconstruction of the torn ligaments is indicated, particularly in professional athletes.

Dr Victor Seah’s preferred technique is the Brostrom-Evans procedure. This is a combination of the Brostrom and the Evans procedure. The Brostrom procedure involves finding the torn ends of the ATFL and the CFL and stitching them back together. In Dr Lee’s experience, especially in active athletes, the Brostrom procedure is usually inadequate for long term stability because the repaired ligaments stretch out over time and become lax.

Therefore, our foot specialist combines the Evans procedure with the Brostrom repair. This involves taking half of the peroneus brevis tendon (which is one of the tendons on the outside of the ankle providing lateral stability) and re-routing it through the fibula bone to recreate a new ligament on the outside of the ankle to reinforce the Brostrom repair.

Rehabilitation for Chronic Ankle Instability

This can be done as a day surgery procedure. After ankle surgery, your ankle will be put into a plaster cast for the first 2 weeks and you will be on crutches. This is to immobilize the ankle and to protect the soft tissues while healing takes place. After 2 weeks, we will change the plaster cast to an aircast.

You can put partial weight on the operated foot for the next 4 weeks. At the end of 6 weeks, you will be allowed to put full weight on the foot and intensive physiotherapy will begin. You should regain full range of motion and stability by about 4-6 months.