Ankle Ligament Reconstruction (Brostrum repair)
Also known as lateral ankle ligament reconstruction (ALR), the aim of this surgery is to restore normal stability to the ankle. Ankle instability can occur for a number of reasons, but is often the result of ligament injury due to repeated ankle sprains. And of course, once you have an unstable ankle, sprains happen more frequently!
As with many other foot and ankle problems, surgery is considered only if your unstable ankle does not respond to the various non-surgical treatments available and six months of non-surgical treatment is often recommended before surgery is advised.
The surgery involves the repair of the ruptured ligaments and the reinforcement of the lateral ankle by tightening the ankle joint capsule.
The most common surgical option is to repair the patient's own existing ligaments with stitches. This repair is often made stronger by support from other tissues. This is referred to as the modified Bröstrom procedure. To strengthen the repair we use a tendon to replace the torn ligaments and the surgeon weaves a tendon into the bones around the ankle, which is held in place with stitches and possibly a screw in the bone. It is possible is to use tissue from the patient's own hamstring tendon, which is taken through a separate incision on the inside part of the knee.
Risks of surgery
Initially the foot will be very swollen and needs elevating. It is very important to elevate the foot for the first 10 to 14 days, as this decreases the risk of infection. As a guide, your foot should be elevated for 50 minutes out of evry hour.The swelling will disperse over the following weeks & months but will still be apparent at 6-9 months.
This is the biggest risk with most types of surgery. Smoking increases the risk dramatically. You will be given intravenous antibiotics to prevent it. The best way to reduce your chances of acquiring an infection is to keep the foot elevated for 10 to 14 days. If there is an infection, it is usually mild and resolves with a course of antibiotics. Rarely, it can be severe requiring further surgery.
There are cutaneous nerves near the incision point and patients commonly have decreased feeling around this area. It is also common to have decreased feeling that extends to the top of the foot. This can be temporary or permenant and ranges from increased sensitivity to complete loss of sensation.
Failure to relieve all symptoms
The results of this surgery are very good and over 90% of patients no longer experience their ankle 'giving way'.
Recovery from surgery
As the surgey involves the tissues that control the stability and movement of the ankle, expect recovery to be a slow process requiring care and patience. The good news is that in a recent study approximately 91 percent of patients reported good to excellent results.
Immediately after surgery your ankle will be protected by a back-slab plaster and you are NOT allowed to put any weight on the foot for two weeks and will need to walk with two crutches. However, for the first 10 to 14 days most of your time will be spent with your foot elevated - so a good time to catch up on any reading.
After 2 weeks the dressing will be removed and the back-slab changed for an AirCast type boot. At this stage some light passive movement physiotherapy usually begins and active movement starts around 4 weeks post-op.
Activity and time off work
Initially your foot will need to be elevated, but with a supportive boot that immobilises the ankle. In general, 4 weeks off work is required, even for office posts. If your job involves standing or walking, then expect 6 weeks and manual or labour intensive jobs around 8 weeks.
- Avoid plantar flexion (up and down flex) greater than resting position for 4 weeks.
- Carefully monitor the incisions and surrounding structures for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization) to decrease fibrosis.
- No running, jumping, or ballistic activities for 3 months.
- Aerobic and general conditioning recommended throughout rehabilitation process.
- Regular appointments for up to 12 months.
Accelerated Brostrum Repair Rehab Process
Download PDF on the Accelerated Brostrum Repair Rehab Process.