Lateral ankle ligament reconstruction surgical technique
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One should be clear of the difference between functional ankle instability, the joint feeling and behaving unstably though with competent mechanical restraints, and mechanical instability where these no longer fulfil their purpose. The former is far more common but the initial management of the post-traumatic unstable ankle is most commonly conservative, irrespective whether functional or mechanical. A successful outcome van be expected in most cases.
It should also be appreciated that some cases with demonstrable lateral ligamentous laxity during examination will be dynamically stable during function having undergone an appropriate course of muscle strengthening and proprioceptive rehabilitation. The indication for a ligament reconstruction is symptoms and a functional problem, and not an examination finding. Such patients rarely require operative management.
If rehabilitation and conservative management fail to stabilise the ankle then the main complaint referable to the ligaments will be one of instability and not pain. Patients with ankle pain as a prominent feature will probably also require an ankle arthroscopy to treat an intra-articular source of pain. It is important in such patients to be clear about the location of the pain. The ankle joint itself is only one possibility as pain can also come also from injury to the postero-medial structures and tendons or postero-lateral tendons after an ankle sprain and this may require additional management.
Patients with atraumatic onset lateral ligament instability are a separate subgroup, who may suffer either with more generalised ligament insufficiency or more rarely neurological issues and require different operative management of their instability than described in this technique.
Readers will also find the description of the Zimmer-Biomet Juggerknot used in a Brostrum ligament reconstruction useful to read at https://www.orthoracle.com/library/brostrom-lateral-ligament-reconstruction-using-juggerknot-suture-anchorzimmer-biomet/
Author: Mark Herron FRCS.
Institution: The Wellington Hospital , London, UK.
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