Visit us for a comprehensive diagnosis and personalised treatment plan.
As the name suggests, minimally invasive ankle ligament reconstruction is a type of surgery performed on patients who suffer from ankle injuries or damaged ankle ligaments to restore ankle stability, improving day-to-day function and allowing patients to resume athletic activities.
Ligament reconstruction can be done for one or multiple affected ankle ligaments. Minimally invasive surgical (MIS) repair or reconstruction of the ankle ligaments can be performed with 2 methods – either through arthroscopic “keyhole” surgery, or by using a percutaneous technique using a single centimetre stab incision. Both MIS surgical techniques leave tiny scars compared to open surgery, and are associated with less post-operative pain, faster recovery, and lower wound complications and infection.
The ankle is involved in important daily activities such as walking, running & playing sports, so recurrent ankle injuries, instability or pain can be debilitating and frustrating ailments to have. There are multiple ligaments in your foot and ankle, with the most commonly injured ones being the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL).
In patients with ankle sprains, the torn or weakened ligaments can be a source of constant pain and repeated sprains, greatly affecting one’s quality of life and increasing one’s risk of recurrent injury. Such patients can develop chronic ankle instability and typically complain of ankle “looseness” and loss of confidence in their ankle. This greatly hinders their ability to participate in sports and dance activities.
Another group of patients who can suffer from recurrent sprains are those with ligamentous laxity, such as connective tissue diseases (Ehlers-Danlos, Marfan’s syndrome) or naturally loose ligaments. These patients may experience frequent ‘rolling’ of the ankle or the sensation of the ankle “giving way”.
If you’ve suffered a severe ankle sprain and have chronic ankle instability or recurrent ankle sprains (from repeated injury), this operation may help improve your quality of life and restore your function.
Your doctor will first evaluate the severity of your ankle injury and assess how it affects your function. A thorough examination of your ankle will be done, to check for areas of instability, tenderness, or weak ligaments. Additional scans such as X-rays or MRIs may be required to accurately diagnose the injury and aid in planning for surgery.
Surgery should be considered when conservative measures such as physiotherapy, bracing, and activity modification have failed to improve the pain and instability symptoms. In such patients who suffer from recurrent ankle sprains, surgical stabilisation of the ligaments is usually indicated to prevent further damage to the joint and improve quality of life.
Conventionally, chronic ankle instability is treated with open reconstruction of the ankle ligaments (Brostrom-Gould technique). During the operation, a 6 to 8cm incision is usually made over the injured ankle ligaments (most commonly over the outer aspect of the ankle), and the ligaments are repaired using stitches. Although results are typically good, the main drawbacks of open surgery are skin complications and infection, significant pain and delayed recovery post-operatively, and unsightly scars along the ankle.
In view of this, arthroscopic ankle ligament repair (arthoscopic Brostrom surgery) has gained popularity in recent years. This “keyhole” operation is typically performed using 2 or 3 small skin incisions (approximately 1cm each), and the repair is performed with suture anchors to fasten the torn ligament ends back to the fibula bone. This arthroscopic technique has shown success rates comparable to open surgery, reduces skin complications and long scars, and facilitates early recovery.
A further refinement of the arthroscopic Brostrom technique has been the development of percutaneous minimally invasive surgery (MIS) Brostrom-Gould reconstruction of the ankle ligaments. This minimally invasive surgical (MIS) technique employs the use of only a single 1cm incision on the outer side of the ankle, and the ankle ligaments are repaired by using a single suture anchor; the repair is reinforced by recruiting an adjacent band of tissue (called the extensor retinaculum) for additional strength. This MIS method for reconstructing the ankle ligaments has been published as the “Lasso” technique and has the distinction of achieving successful outcomes using only a single 1cm incision.
The MIS “Lasso” technique for percutaneous ankle ligament reconstruction results in minimal pain and swelling after surgery, facilitating rapid recovery and early return to high-level sports and dance activities. In addition, the single 1cm incision minimises the risk of skin complications and infections and leaves a scar that is often hardly visible. It is a short procedure that is performed in the Day Surgery setting, typically taking far less than an hour.
In some cases, additional treatment may be recommended based on the presence of co-existing injuries to the cartilage in the ankle joint (osteochondral lesions) or to the peroneal tendons. Osteochondral lesions of the ankle joint, if significant in size and causing pain, may be addressed by ankle arthroscopic microfracture or retrograde drilling techniques to stimulate cartilage regrowth. The risk of developing osteochondral injuries increases with every subsequent sprain, hence it is important to treat recurrent sprains early.
Peroneal tendon injuries may require a period of immobilization in a walker boot and/or autologous plasma therapy injections to promote healing; in the most severe cases, the peroneal tendons may have to be surgically repaired.
After the surgery is completed, you will be kept on protected weight bearing for 2 weeks, thereafter, you can return to walking in a boot, and commence physiotherapy for early rehabilitation (with precautions to avoid reinjury). At 6 weeks after surgery, you can progress to unrestricted physiotherapy to restore the full range of motion and strength in the ankle. Most patients are expected to progressively return to sports and dance activities at 3-4 months after MIS ankle ligament reconstruction surgery.
There are a host of benefits when opting for minimally invasive ankle ligament reconstruction:
Minimally invasive ankle ligament reconstruction is generally a very safe procedure and has a low risk of side effects. Nevertheless, as with any surgery, there are some risks that patients should be aware of:
Minimally invasive surgery (MIS) involves very small wounds, lowering the risk of germs entering the wound and causing infections.
Some patients may experience stiffness or swelling immediately after surgery, but these symptoms will likely resolve with time and can be aided by physiotherapy. This is significantly reduced in MIS surgery, as there is minimal injury to the soft tissues.
This may lead to temporary numbness, but the risk of this occurring is low, as the sites where the incisions are made will be carefully planned out prior to the surgery.
The main alternative to minimally invasive ankle ligament surgery is traditional open surgery, which involves a markedly larger incision and more damage to surrounding soft tissue and muscles. Open surgery is associated with more pain, longer recovery time, more complications, and poorer cosmetic outcomes.
If you are a candidate for surgery but choose not to undergo ligament reconstruction, there are some potential long-term side effects such as chronic ankle instability and injury to the joint, which may affect your ability to walk, run or engage in sports properly.
Which can progress to ankle osteoarthritis if treatment is delayed. Furthermore, you put yourself at risk for other injuries such as ankle fractures, tendon injuries and muscle tears every time you sprain your ankle. Hence, it is important to seek treatment early and restore stability to the ankle joint as soon as you can.
If you are experiencing symptoms of ankle pain and instability, or have recurrent ankle sprains, it is advisable to speak to a doctor to obtain an accurate diagnosis and to discuss the appropriate treatment.
Ankle ligament injuries are very common, and seeking treatment for ankle instability early will enable you to attain excellent outcomes. Refractory chronic ankle instability can be treated readily with minimally invasive surgical (MIS) reconstruction of the ankle ligaments, which will prevent long term complications like osteoarthritis, improve your quality of life, and allow you to enjoy your favourite activities again. This can be achieved through a single centimetre long incision, leaving a barely visible scar!
Our friendly team is here to serve you. For urgent enquiries and appointment requests, please call or WhatsApp us directly.
