Treatment of Ankle Instability- A Surgical Approach

According to Martin J. O’Malley, MD, Associate Attending Orthopaedic Surgeon at the Hospital for Special Surgery (HSS), surgical intervention falls into two main categories.

Anatomic reconstruction

The preferred is an anatomic reconstruction, in which the stretched or torn ligaments is repaired and allowed to heal in a shorten position. This reconstruction can be accomplished by using the patient’s own tissue, also known as a Broström procedure, or utilize a cadaver tendon, also called an allograft, if the patient’s own tissue is too stretched out or different. For added stability and to help prevent re-injury, the surgeon may also tighten the retinaculum, a band of fibrous tissue that helps hold the ankle in proper alignment.

In almost all cases, anatomic reconstruction is possible and preferable. This procedure offers the advantages of maintaining full mobility of the joint, a smaller incision, and a more rapid recovery. The primary drawback of this procedure is that ligaments may become loose a second time and require additional repairs, but this is rare. Results of the Broström procedure performed are excellent. In a case series of seventy-three patients, all but one was satisfied with the procedure and would have the procedure again.

Peroneal substitution

The second type of surgery is peroneal substitution ligament reconstruction, a procedure in which the ligament is replaced entirely with another piece of tendon from the patient’s ankle. This procedure is less ideal as the main dynamic stabilizer of the ankle, the peroneal tendon, is used.

Peroneal substitution ligament reconstruction requires a larger incision than anatomic reconstruction, has a somewhat longer recovery period, and carries a risk of nerve irritation, which can lead to chronic pain.Non-anatomic personal substitution ligament reconstruction is rarely used because it sacrifices a good tendon, has higher instances of post-operative stiffness and pain.