Ankle Ligament Reconstructions (Broström Procedure)

 

When Is Ankle Ligament Reconstruction Recommended?

Ankle ligament reconstruction is recommended in cases of injuries and their pathologic consequences, such as:

• damage to the ankle syndesmosis;
• rupture of the lateral ankle ligament;
• sprains of the ankle ligaments;
• repeated and recurrent dislocations and subluxations of the ankle joint;
• chronic instability with limited mobility, constant pain and discomfort.

In some cases, the consequences of injuries are treated conservatively (rest, immobilization, physiotherapy, painkillers, orthopedic insoles and bandages). If conservative treatment does not result in improvement of symptoms within 6–12 months, surgical intervention may be considered.

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Preparation for Surgery

There are a number of preparatory steps to be taken before surgery to ensure the best results and a safe operation.

1. Consultation with a surgeon: history, examination, determination of the extent of damage from diagnostic imaging, and selection of an appropriate reconstruction method. You may be given blood tests, EKG and other tests to assess your general health and make sure you are ready for surgery.
2. Preoperative recommendations:

• 2–4 weeks before the operation, it is necessary to completely stop smoking, as nicotine can slow down wound healing and increase the risk of complications;
• stop taking medications that affect blood clotting;
• adhere to a healthy diet rich in protein and vitamin C, which are important for wound healing;
• limit physical activity for a few days before surgery;
• shower with antibacterial soap and water the evening before surgery.

On the day of surgery:

• do not take food or water 6 to 8 hours before surgery;
• take any medications authorized by your surgeon with a small amount of water.

 

The Ankle Ligament Reconstruction Procedure

Ankle ligament surgery involves various reconstructive techniques and surgical methods.

1. Types of surgery

• Open reconstruction: the surgeon makes an incision over the injured ligament, removes the damaged tissue, and reconstructs the ligament using tendon or other tissue from the patient's body (autograft) or donor tissue (allograft).
• Arthroscopic reconstruction: instead of an incision, small holes are used through which tiny instruments and a camera are inserted into the joint. This method is less invasive and has a lower risk of complications.

2. Operative techniques

Depending on the nature of the injury, different operative techniques may be used.

• Anderson-Jones method: used to repair the Achilles tendon (on the back of the lower leg). A tendon from the long fibula is grafted and used to strengthen the damaged Achilles tendon.
• Achilles’ tendon advancement: this technique is used to repair the posterior talofibular ligament (Achilles tendon). The Achilles tendon is lengthened and moved to a stronger position to provide stability to the joint
• Broström reconstruction is the most common technique used to reconstruct the lateral (outer) ligament of the ankle.

3. Operation steps (Broström technique)

• The surgeon makes an incision over the damaged lateral ankle ligament.
• He removes the damaged part of the ligament.
• The tendon from the tibialis anterior muscle (on the outside of the tibia) is extracted and prepared for use as a graft.
• Small tunnels are made in the tibia and talus bones.
• The tendon graft is threaded through the tunnels and fixed in the correct position with sutures, screws or pins.
• The incision is sutured.

The most common material for reconstruction is tendons from the tibialis minor muscle. In some cases, donor tissues may be used if the patient does not have enough of his or her own tissue for reconstruction.

Strong threads are used to fix the graft in the correct position, and screws or pins are used for additional fixation. In some cases, surgical mesh may be used to strengthen the joint capsule.

 

Recovery and Aftercare

Full recovery after surgery may take several months. During this time, you will need to follow your doctor's recommendations.

Care recommendations

1. Apply ice to the swollen area for 20–30 minutes several times a day for the first few days after surgery.
2. Keep your leg in an elevated position as often as possible to reduce swelling.
3. Follow your doctor's instructions for caring for your postoperative stitches.
4. Avoid putting stress on the operated leg.
5. Wear an orthopedic boot or special shoes as recommended by your doctor.
6. Follow all recommendations from your physical therapist - exercises to strengthen muscles, regain strength, flexibility and range of motion of the ankle.

Benefits of Ankle Ligament Reconstruction at Our Clinic

When you choose Illinois Foot & Ankle Clinic, you get access to highly skilled specialists, advanced technology, and personalized care. Our experience and benefits make us the ideal choice for ankle ligament reconstruction.

Schedule a consultation with our specialists to clarify your diagnosis and find the best treatment. Phone - (847) 298-3338, Des Plaines.