Chronic Ankle Instability

What is Chronic Ankle Instability?

Chronic Ankle Instability is a condition that may develop after an ankle sprain, resulting in ruptured ligaments on the outer side of the ankle. Most patients recover from an ankle sprain by simple measures as icing, analgesics, bracing, physiotherapy and gradual return to physical activities. However up to 20-40% of patients may continue to experience symptoms of ankle instability such as giving way, insecurity playing sports, pain or locking. Untreated instability may lead to inflammation inside the ankle joint called synovitis, further cartilage damage, bone spurs ultimately leading to arthritis. In case of unsuccessful non operative treatment it is worth seeing an orthopaedic surgeon, where following a history taking, clinical exam and investigation review, discussion can be carried out about operative treatment.

What does the All Inside Brostrom operation entail?

Operation can be carried out under a regional block, general or spinal anaesthetic. First the ankle is examined under x-ray guidance to asses the instability. Thereafter, via small incisions a camera called arthroscope along with other instrument is introduced to the joint to assess and address the changes. After any cartilage defects or bone spurs impeding free movement of the joint were addressed, All inside Brostrom ligament repair is performed. Often lengthened and loose ligament on the outer side of the ankle called ATFL is sutured tightening it and reinforced with fibre tape augment called internal brace.

How to achieve optimal post operative recovery?

• 0-2 weeks

  • Rest, analgesics and elevation to a heart level is recommended to decrease swelling.

  • Bulky bandage and orthopaedic walker boot is worn 24/7, including night time, to optimise wound healing

  • Immediate weight bearing is permitted from day one, but accumulated weight bearing should not exceed 1hr a day

  • Thromboembolic prophylaxis is only recommended for 2 weeks if the risk of deep vein thrombosis is increased

• 2-6 weeks

  • wound healing check is carried out at 2 weeks post operative visit

  • Showering without wound protection generally can be commenced

  • Orthopaedic walker boot is now worn only during day time sleeping without the boot.

  • Walking distance with a walker boot is gradually increased

  • Gentle dorsal and plantar flexion exercises without the boot are now allowed.

  • Core strengthening, stationary cycling, upper body exercises, open chain hamstrings and quadriceps exercises wearing a boot help to maintain general fitness during this stage of recovery

• 6 - 10 weeks

  • At 6 weeks postoperative visit healing and stability is checked.

  • Brace should not be worn for regular walking

  • More vigorous physiotherapy exercises concentrated on calf stretches, inversion, eversion motion, peroneal and calf strengthening, stability platforms are commenced. Swimming can be commenced.

  • From 8 weeks jogging with an athletic ankle brace can be commenced with gradually progressive intensity.

• 10 - 12 weeks

  • Side running, plyometric training, cutting and pivoting drills can be commenced, based on achieved strength in comparison to the other leg using athletic ankle brace or taping.

  • Sport specific predictable drills can be commenced using athletic ankle brace or taping.

Treatment with Arthroscopic repair and augmentation of the lateral ankle ligaments (All-Inside Brostrom)