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Ankle Ligament Repair/Reconstruction

Ankle ligament repair or reconstruction is a surgical procedure used to treat chronic ankle instability caused by repeated sprains or ligament damage. This procedure is supported by strong evidence indicating improved stability, reduced pain, and a lower risk of future sprains when conservative treatments have failed.

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The lateral ankle ligaments, particularly the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), are most commonly affected. If these ligaments fail to heal properly after injury, the ankle may remain unstable, increasing the risk of further sprains and arthritis.

What Does the Surgery Involve?

The choice of procedure depends on the extent of ligament damage:

  • Ankle Ligament Repair (Broström Procedure):

    • Used when the ligaments are stretched but still viable.

    • Involves tightening and suturing the torn ligament back to the bone.

    • Reinforced with stitches or anchors.

  • Ankle Ligament Reconstruction:

    • Used for more severe cases or previously failed repairs.

    • A tendon graft (from the patient or a donor) replaces the damaged ligament.

    • May involve additional stabilization procedures if necessary.

The surgery is usually performed under general or regional anesthesia.

Alternative Treatments

Before considering surgery, non-operative management includes:

  • Physiotherapy – Strength and balance exercises to stabilize the ankle.

  • Bracing – Ankle supports to reduce instability during activities.

  • Activity modification – Avoiding high-risk movements.

  • Prolotherapy or PRP injections – Emerging treatments to stimulate ligament healing (limited evidence).

If these treatments fail and the ankle remains unstable, surgery is recommended to prevent long-term damage.

Risks and Complications

Potential risks include:

  • Infection (low risk)

  • Nerve injury (temporary numbness in some cases)

  • Blood clots (DVT)

  • Persistent pain or stiffness

  • Delayed healing or re-injury

  • Ankle weakness or stiffness (rare)

Success rates for ligament repair or reconstruction exceed 85–90%, with most patients regaining full function.

Recovery and Rehabilitation

Time Off Work

  • Desk jobs: 2–3 weeks

  • Manual labor: 8–12 weeks.

 

Return to Driving

  • Usually 6–8 weeks, depending on the foot operated and recovery speed.

 

Return to Activities & Sports

  • Light activities: 6–8 weeks

  • Running: 3–4 months

  • Full sports: 4–6 months

 

Rehabilitation involves

  • Immobilisation – Boot or splint for the first 2–4 weeks.

  • Physiotherapy – Balance, strength, and agility training.

  • Gradual return to sports – Supervised by a physiotherapist.

  • Long-term studies suggest that most athletes return to pre-injury levels of activity, with improved stability and function.

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