As mentioned before, the overwhelming majority of ankle sprains will
get better with conservative care in 2-3 months. Once x-rays have
confirmed there isn’t any fracture, most sprains get better with
R.I.C.E., as well as bracing and protection. However, there are some
people who will continue to have pain and discomfort despite our best
efforts. The decision to go ahead with surgery is one that is
complicated. Both the patient and doctor will have to discuss and agree
upon a plan as a team. Let’s discuss some options.
One attractive
option is to do ankle arthroscopy. Similar to what is done in the
knee, a small fiber-optic camera is inserted into the ankle joint along
with a tool to remove any loose particles inside the ankle joint. With
multiple ankle sprains, pieces of bone, cartilage, or inflamed ligaments
can impinge on the ankle joint. Once loose particles are removed, pain
is lessened and improvement is seen. The main advantage to ankle
arthroscopy is that there are only 2 small incisions made where the
instruments are inserted. The incisions heal quickly and downtime is
usually 10 days to 2 weeks.
Another procedure that can be done is
called a Brostrom procedure. As we discussed, ankle sprains can cause
ligaments to tear. The Brostrom procedure attempts to sew back together
a ligament that is often torn in ankle sprains. It is sewn together
with a very strong suture material, so that stability is gained and pain
is minimized. This procedure requires a longer healing period as the
ligament fiber ends need to reconnect.'
In some cases, torn
ligaments are so bad that it is impossible to sow them back together.
In these cases, grafts can be used. There are many variations to what
can be done to recreate the ligaments. The doctor can use a graft made
from bovine or porcine sources, or harvest tendon from another source in
the body. Depending on which ligaments are torn, the doctor can adjust
what he uses to restore stability.
There are additional
procedures that exist to help a persistent ankle sprain. Work with your
doctor to decide which procedure best fits your situation.
