Ankle Ligament Reconstruction

The most frequently performed procedure, the Broström repair, involves tightening and reattaching damaged ligaments, primarily the anterior talofibular ligament (ATFL) and sometimes the calcaneofibular ligament (CFL). This technique restores stability using sutures or anchors and is ideal for cases with sufficient ligament quality.

This variation of the Broström repair adds reinforcement using surrounding tissues, such as the inferior extensor retinaculum. It is commonly used for patients with severe instability, poor ligament quality, or higher physical demands.

For cases where the ligaments are too damaged for direct repair, a tendon graft is used to reconstruct the ligaments. Autografts (from the patient’s own body, such as the hamstring or peroneus longus tendon) or allografts (from a donor) provide strong and durable support for stabilising the ankle.

Anaesthesia is provided either as general anaesthesia or a regional nerve block, depending on the patient’s condition and surgical plan. Vital signs are continuously monitored throughout the procedure. A tourniquet is applied to the thigh to minimise bleeding during surgery.

The ankle is cleansed with an antiseptic solution, and sterile drapes are placed to maintain a sterile field. Key anatomical landmarks and planned incision sites are marked on the skin. Initial arthroscopy may be performed to evaluate joint surfaces and rule out additional injuries.

An incision is made over the lateral ankle to access the damaged ligaments. The surgeon evaluates the extent and pattern of ligament injury. Any scar tissue or debris is removed to create a clear repair site.

For ligament repair, torn ligaments are reattached to the fibula using bone anchors. In cases requiring a graft, bone tunnels are drilled at precise locations, and the graft is passed through these tunnels before being secured with screws or anchors. Additional reinforcements may be added if necessary to enhance stability.

The surgeon assesses ankle stability through range of motion testing before closing the wound. Deep tissue layers are sutured with absorbable material, while the skin is closed with fine sutures or staples. A sterile dressing and a compression bandage are applied to protect the surgical site and reduce swelling.

The ankle is immobilised with a splint or cast, and the leg should remain elevated above heart level to reduce swelling. Ice therapy helps manage discomfort, and weight-bearing is avoided. Crutches are required for mobility during this period.

A removable boot replaces the cast, and gentle range of motion exercises begin under physiotherapy guidance. Weight-bearing gradually transitions from non-weight-bearing to partial weight-bearing. Sutures are typically removed around the two-week mark.

Strengthening exercises focus on rebuilding ankle muscles, while balance and proprioception training restore stability. Normal footwear is resumed, and low-impact activities begin by weeks 8–10. Running typically starts at 3–4 months, with full return to sports by 5–6 months, depending on progress.