Dr Senthilvelan. R
MBBS, FRCS(Orth, UK), FEBOT(France), D Orth, Dip SiCOT
Consultant Orthopaedic Surgeon
Fellowship in Foot and Ankle Surgery(UK)

Ankle sprains are one of the most common leg injuries. Although most people recover without significant long term consequences, chronic problems of ankle does develop in about 20 % of patients. This problem is called Chronic ankle instability.

When somebody develops a twisting injury to ankle the ligaments in the ankle joint can get damaged. The commonest ligament to be damaged is called Anterior Talofibular ligament. There are different grades of injury to this ligament.

Most of injuries are grade 1 or grade 2 when only a few fibres are damaged. This kind of ankle sprains recover normally without long term consequences. The initial treatments for Grade 1 injuries are rest, elevation, ice packs.

Subsequently once the initial pain in ankle settles down ankle proprioception exercises and muscle strengthening exercises are started.

Some patients who have grade 3 sprains (severe variety) develop symptoms of persistent pain and feeling of ankle instability. Such patients may experience increased frequency of subsequent ankle sprains. They also feel they cannot “trust” their ankle anymore. This is because the ligaments in ankle carry position sense to the brain and when they don’t heal properly after severe injuries this position sense otherwise called proprioception is affected. Such patients are classed to have chronic ankle instability.

The treatment for patients with chronic ankle instability is muscle training, balance training, and external bracing. Most of times patients get better with conservative measures of treatment.

If symptoms persist even after these conservative measures are undertaken surgery to reconstruct the ligament will benefit the patient. Earlier the surgery to reconstruct the ligament was done using open methods. Now this same surgery can be done by arthroscopic (key hole) means. This is usually done under Regional block ( injection in the spine or Leg) to numb the leg.

The Procedure is called Arthroscopic Ankle Lateral Ligament repair. It involves making two small keyhole size incisions in front of ankle . The camera and instruments are inserted in these keyholes and the ligaments are repaired using specialised instruments and anchors . After surgery the ankle is placed in plaster for two weeks for rest . After two weeks the plaster is usually removed and ankle brace is fitted. Specialist Physiotherapy is started from this point to rehabilitate the ankle.

Ankle arthroscopic surgery reduces the recovery time and induces less trauma to tissues. Doing the surgery by arthroscopy can also address other issues of present inside the ankle joint.