ANKLE LIGAMENT RECONSTRUCTION
WHAT IS ANKLE INSTABILITY?
Ankle instability is a disorder characterized by a feeling of excessive weakness or laxity in the ankle joint, making it difficult to maintain stability and balance during physical movements or activities. This condition can result from a variety of factors, including previous traumatic injuries, anatomical abnormalities, ligament or muscle deficiencies, or problems with proprioception (the body’s ability to perceive its position in space).
The main causes of ankle instability include:
- Repeated anterior sprains : Severe or repeated sprains of the ligaments around the ankle can weaken these structures and lead to chronic instability.
- Ligament Injuries : Traumatic injuries to the ankle ligaments, especially the lateral ligaments (like the lateral collateral ligament), can cause instability if they do not heal properly or are improperly treated.
- Anatomical abnormalities : Anatomical variations such as congenital ligamentous laxity or structural abnormalities of the ankle joint may contribute to instability.
- Muscle weakness or muscle imbalances : Weakened muscles or a muscle imbalance between the stabilizer and antagonist muscles of the ankle can compromise the stability of the joint.
Common symptoms of ankle instability include:
- A feeling of weakness or laxity in the ankle
- Recurrent episodes of “rolling” or “turning” of the ankle
- A feeling of imbalance or inability to maintain stability when walking, running, or other physical activities
- Chronic pain around the ankle joint
- Persistent swelling or inflammation
Treatment for ankle instability depends on the underlying cause and the severity of the symptoms. It may include non-surgical options such as physical therapy, muscle strengthening, wearing ankle support devices, as well as surgical procedures such as ligament repair or ligament reconstruction in more severe cases. A thorough medical evaluation is essential to determine the best treatment plan for each patient.
WHY AN OPERATION?
Some sports or daily activities are impossible in the absence of effective external lateral ligaments, and can lead to instability accidents and cause cartilage damage. In this context, the natural progression is the gradual deterioration of the joint.
The objective of the reconstruction is to recover a perfectly stable ankle to be able to carry out all types of activities, thus preventing cartilage damage and the deterioration of the joint.
WHAT IS ANKLE LIGAMENTOPLASTY?
Ankle ligamentoplasty is a surgical procedure that aims to restore stability to the ankle joint by rebuilding or strengthening damaged ligaments. This procedure is often performed to treat severe ankle sprains, chronic instability, or other conditions that compromise the stability of the joint.
Here is how an ankle ligamentoplasty generally takes place :
- Patient preparation : Before surgery, the patient is usually placed under general or regional anesthesia to ensure comfort during the procedure. Preoperative tests such as X-rays or MRIs may be performed to assess the extent of ligament damage.
- Incision and access to the joint : The surgeon makes an incision near the ankle to access the joint. The size and location of the incision depends on the specific surgical technique used and the needs of the patient.
- Preparing the fixation sites : Once access to the ankle joint is obtained, the surgeon prepares the sites where the new ligaments will be attached. This may involve cleaning the bone surfaces and creating bone tunnels to allow passage of ligament grafts.
- Graft Harvesting : In many cases, the surgeon uses a graft to reconstruct the ankle ligaments. This graft can come from a part of the patient’s body (autograft), such as a tendon from the knee or foot, or from an external source (allograft). The graft is carefully harvested to ensure proper adaptation and tensile strength.
- Fixation of the graft : Once the graft is ready, the surgeon fixes it in the prepared bone tunnels using screws, pins or other fixation devices. This helps stabilize the ankle joint and promote healing of the new ligament.
- Closing the incision : Once the ligament reconstruction is complete, the surgeon closes the incision with sutures or staples and applies a sterile dressing to protect the surgical area.
After ankle ligamentoplasty, the patient is usually closely monitored for any postoperative complications and is referred to a specific rehabilitation program to promote healing, strengthen the ankle muscles, and improve joint function. Recovery time and results of surgery may vary depending on several factors, including the severity of the initial injury, the patient’s overall health, and compliance with rehabilitation recommendations.
