The Foot and Ankle Clinic

Ankle sprain

What is an ankle sprain?   |  The ankle ligaments injured by an ankle sprain  |  What else can be injured?   |  What symptoms might I have with an ankle sprain?   |  How common is a sprained ankle?  |   What is the difference between an ankle sprain and an ankle ligament rupture?   |  What treatments are available for a sprained ankle?   |  Which is the best treatment for an ankle sprain?   |   What sort of ankle brace to use for an ankle sprain?   |  Functional rehabilitation after ankle sprain   |  What is the expected natural history after an ankle sprain?  what if it doesn't get better?  When would an operation be appropriate?   |  What operations are available to stabilise the ankle?   |   Does the ankle ever "give" the other way (the foot facing outwards, rather than inwards)


When is an Operation Appropriate After an Ankle Sprain or Ligament Rupture?

The most common scenario is if the conservative (non operative) route fails to get the ankle better.

Operative intervention is used for two sets of symptoms, which may co-exist. These ongoing symptoms following an ankle sprain are either pain at the level of the ankle or instability from the ankle. If, following an ankle sprain the ankle is "just" painful then an arthroscopy may be all that is required. At arthroscopy any areas of loose cartilage or inflamed tissue (synovitis) or scar tissue (arthrofibrosis) can be removed from the joint. The timing of ankle arthroscopy following an ankle sprain is open to discussion depending on individual wishes/requirements.

There is debate (and evidence both ways) about whether operative repair of the ligaments early, without first failing conservative treatment, is justified.

Anterior ankle synovitis, before and after removal with an arthroscopic shaver

Anterior ankle synovitis before and after removal with an arthroscopic shaver

If ankle instability is also a problem following ankle sprain then the ligaments may or may not need to be repaired as well. The ankle stability should be tested during the ankle arthroscopy.

What operations are available to stabilise the ankle?

There are two types of operation generally to stabilise the unstable ankle. These can be grouped either into a direct repair of the injured ligaments (known generically as a Bostrum type ankle ligament repair)

Bostrum type ankle ligament repair
To view Surgeon's operative manual,
go to The Foot Surgery Atlas

or a reconstruction (re-making) of the lateral ankle ligaments using tissue, either locally or from elsewhere.

Reconstruction of the lateral ankle ligaments

A lateral ligament reconstruction using a Wright Medical Graftjacket ligament

Does the ankle ever "give" the other way (the foot facing outwards, rather than inwards)

Yes. This is far less common, perhaps even twenty times less likely to occur than a lateral ligament injury.

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