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Surgery for Chronic Ankle Sprains

Although the surgical procedures is not the focus of this blog, I would like to share with everyone a new technique that we are performing in our practice. The majority of ankle sprains do not require surgical treatment. In fact, most athletes are able to return to running and competition within 2-3 weeks of an acute ankle sprain. Even a severe sprain can go on to an almost normal recovery. Sometimes however,  the condition becomes chronic which typically occurs over several years.  One usually encounters sprains of the ankle by just stepping of a curb the wrong way, or even periodically during a season of competition. When this occurs, your ankle may be inhibiting you from performing the activities you otherwise would be able to do. Surgery is usually indicated at this point.

In the past, surgery typically involved a primary repair (tightening of the ligament itself) or a secondary repair (utilizing the patients own tendons to recreate a ligament). While these procedures work well, they do have some complications. The primary repair which involves tightening the ligament itself, is only as strong as the ligament that remains.

Primary repair where suture is used to tighten the ligaments.

There are numerous variations of secondary repair most of which involve harvesting a portion of the peroneous longus tendon and using it to augment and/or recreate the ATF and CF ligaments. When the peroneous tendons are sacrificed for utilization in repairing the ligaments, the tendon itself has to undergo a healing and repair process adding to further swelling and pain post operatively. In essence, not only does the ligament repair need time for healing, the disrupted tendon now has to heal and repair. It’s almost as if the patient is healing two procedure instead of one.

Secondary repair involving harvesting a peroneal tendon for recreation of the lateral ligamentous complex.

The technique performed on the patient in the video below involved recreating of the ATFL and CFL with the use of a product known as Fibertape by Arthrex. Fibertape is an ultra-high strength suture material that is anchored into the bone at the sites corresponding to the attachments of the ligaments.  A corkscrew anchor provides a tight fit resisting the ability to be pulled out.  The Fibertape is described by Arthrex as being an augmentation to the existing ligament, but in actuality it is much stronger then the body’s own ligament tissue and provide more support then just augmenting the ligament itself.

Fibertape and Tigertape by Arthrex
Small IB
Augmentation of a primary repair with the Arthrex Fibertape

See the video below revealing the improvement in strength of the ligaments and minimal swelling at just 3 weeks post operatively. 

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