Ankle ligament reconstruction - Modified Brostrum procedure


What is ankle ligament reconstruction?

ligmentWhen the ligaments on the outer side of the ankle joint are torn it causes ongoing instability (giving way of the ankle) which can lead to arthritis in the long term. A repair of the ligaments is necessary to tighten up the ankle and prevent further episodes of twisting.

There are two main ligaments which will be repaired and tightened.

The surgery involves a skin incision on the outer aspect of the ankle and the two ligaments are re-attached and tightened, using a tiny metallic anchor to which the stitches are attached into the bone (the fibula).

Type of procedure

This is a day case procedure and same day discharge is usual.

Type of Anaesthesia?

The operation will be undertaken under a light general anaesthetic supplemented with an injection around the ankle to numb the foot (nerve block). The effect of this block will last for a few hours after surgery.

How long will the surgery take?

This depends on the type of procedure being carried out.Usually 30 minutes to 60 minutes.

Risks of surgery

Any orthopaedic surgery carries some inherent risks and it is the surgeons responsibility to fully inform you regarding the benefits and risks of this procedure. Mr Shariff will go through this in detail with you to help you make an informed decision.

This is a fairly routine procedure with risk of:

Infection:

If this occurs it is usually a superficial infection around the wound site. It settles with a course of oral antibiotics. Deep infection is extremely rare. Overall risk is 1%.

Numbness:

There may be accidental damage to a small branch of the nerve which supplies sensation to the top of the foot. This may result in numbness or pins and needles. Risk is approximately 5%.

 

Recovery from Surgery

What can I expect immediately after the surgery whilst in hospital?

When you wake up, it is normal to have numbness in the operated foot as the anaesthetic block will take a few hours to wear off. You will have a bulky dressing to your foot. The physiotherapists will make sure that you are safe on your feet before discharge. Crutches will be provided and you will be taught how to use them. You will also be given painkillers to take home. It is normal to experience moderate pain after surgery and you can keep this to a minimum by taking regular painkillers.

Specific recovery protocol:

Day 1 - 7

  • Ensure that you keep your foot elevated on pillows to help reduce swelling.
  • Foot wrapped in bulky bandage and a boot.
  • Ice, Elevate leg and take pain medication.
  • Expect numbness in foot 12-24 hours then moderate pain.
  • Do not change bandage.

Day 14

  • You will have a follow up visit in clinic.
  • Your wound will be inspected. You will have non absorbable sutures so they will have to be removed.
  • You can walk in a post operative boot which will be provided to you.

6 weeks

  • The boot will be removed at this stage.
  • Physiotherapy will be commenced.
  • You will be provided with a ankle strap up brace.


Post operative clinic visit schedule

  • 2 weeks after surgery - wound check and advice regarding basic hygiene
  • 6 weeks after surgery - clinical examination
  • 3 months after surgery - final follow up and discharge

When can I begin to walk?

You will be able to start walking within 2 weeks of surgery once the wound is healed. You should ONLY walk in the boot provided to you to protect the repair until it heals up completely.

How do I look after my surgical wound site?

Your wound should be healed 2 weeks after surgery. If you notice any redness around the wound site, get in touch with your consultant as you may have a wound infection. Do not pick on any scabs and allow them to fall off. You will be taught some massage techniques to lighten your scar.

How do I shower or wash?

Do not get your wound wet until it heals completely. You can use a waterproof cover or plastic bag over your foot when you have a shower. Only expose your wound to water after it has healed completely.

When can I get back to driving?

It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times. As a general rule, you are ready to drive when you are able to perform an emergency braking manoeuver without pain. This usually is within 4 - 6 weeks after surgery. Please find the DVLA guidelines on safe driving in the documents section.

 
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