22 Aug The Various Methods of Ankle Ligament Stabilization
Lateral ankle sprains are among the most common injuries presented to a podiatric by mainly sportsmen and sportswomen. Eight out of ten cases of lateral ankle strains heal naturally with the application of conservative management and physical rehab. However, the two cases that do not heal by application of conservative care and physical therapy requires surgical to rectify the damage.
This is necessary because if the injury is severe, i.e. lateral collateral ligaments injury; it can cause ligamentous laxity and neuromuscular insufficiency resulting in chronic lateral ankle instability. Early diagnosis and appropriate treatment of lateral ankle sprains or injuries are essential in preventing cases such as chronic instability, pain, swelling, and degenerative joint changes commonly seen in the chronically painful and unstable ankle.
Ankle ligament stabilization may require surgery only when symptoms after a physical rehab program for the ankle injury persists. These symptoms include recurrence of ankle strain or the third-degree distal talofibular ligament strain that causes opening of the talar mortise. Distal talofibular ligament strain is rectified by suturing ligaments together.
Methods of ankle ligaments stabilization
Split Peroneus Brevis lateral ankle stabilization technique
This is an earlier technique for stabilization of the unstable ankle which used the Peroneus Brevis tendon as tendon graft to substitute the weakened or injured ankle ligaments. The technique involved making a cut on a single curvilinear of the ligament and transferred of tendon graft from the neighboring tendon to the body of the calcaneus in a trephine hole. Therefore, patients’ mobility is hindered, and they required much rehabilitation after an operation due to many dissections around their ankle.
The Modified Evans Ankle Stabilization
Evans Ankle stabilization techniques involved detaching the Peroneus Brevis tendon from the muscular-tendon junction, and then the residual muscle belly of the Peroneus Brevis would be sutured to the Peroneus Longus tendon. The Evans process has been adjusted by members of the Podiatry Institute by utilizing one-half of the Peroneus Brevis tendon moved through a canal in the distal fibular and implanted into the lateral calcaneus. Therefore, utilizing three separate skin and deep fascia incisions, thus decreasing the amount of surgical dissection, swelling after an operation, pain, and rehabilitation.
The procedure involves folding the anterior capsule-ligamentous complex with approximation and reefing of the extensor digitorium Brevis muscle belly. Hence, lateral collateral ligaments are not rebuilt in William’s technique, and functional stabilization of the ankle joint is enhanced without the interference of biomechanics.
The Brostrom-Gould Procedure
The Brostrom-Gould procedure involves making a cut on the outer side of the ankle and finding ligament remains. Then minor slots are made in the bone on the outer side of the ankle, and the found ligament is reattached to the bone using specialized sutures. Skin closure and application of plaster to the leg follows afterward.
Traditional surgical procedures which are single or double ligament repair with the use of autogenic or allogenic grafts to reinforce the impaired lateral structures can also be used for ankle ligament stabilization. However, they require many and large incisions accompanied by the complicated moving of neighboring tendon structures. Post-surgical complications such as nerve complications, stiffness, recurrent instability, degenerative joint disease, and osteophyte proliferation are common with the traditional surgical procedure. Therefore, today they are rarely used for ankle ligament stabilization