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Broström Lateral Ligament Repair

What is a Lateral Ligament Repair

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Rupture of the lateral ligaments of the ankle is extremely common. Fortunately many people who rupture their lateral ankle ligaments do not suffer from recurrent instability. Physiotherapy can teach most patients how to keep the ankle stable. Also some people decide to play sport with a brace rather than go through surgery.

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High level athletes and individuals who have recurrent instability require surgery. Lateral Ligament Repair can be performed through a small incision on the outer border of the ankle. The ligaments which have been elongated by the injury are tightened.

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It is normal to have an ankle arthroscopy at the same time to tidy up any scar tissue or other problems within the ankle.

What can I expect on the day of surgery?

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  • The surgery will normally be under a general anaesthetic.

  • Normally this is a day surgery case (unless the surgery is combined with a surgery to realign a bone which is a bigger surgery).

  • I will numb the ankle with local anaesthetic so that you will be comfortable when you wake.

  • There will be a big bandage on your ankle which you will keep clean and dry

  • You will be placed in a removable boot (such as the Aircast boot)

  • You will be given crutches and told to weight bear in the boot with the aid of crutches as needed

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What are the risks and complications?

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The vast majority of patients do extremely well. A small group of patients need extra physio due to swelling or stiffness. Rare complications include infection, blood clots (DVT), nerve damage, tendon injury & failure to improve.

Re-rupture is rare but it can occur.

When can I drive?

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The best guide that you are safe to return to driving is that you are able to walk well without crutches. The usual time scale also depends on whether you had surgery on your right or left foot and whether you drive a manual or an automatic

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  • Right side and all car types: 6 wks

  • Left side and manual car:     6 wks

  • Left side & automatic car:     2 wks

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How long should I take off work?

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The time you require off from work depends on what type of job you do. The first two weeks of healing are critical and so you must have this time off work. Many people are able to work from home and so if you can avoid commuting in the first six weeks, you will find that your ankle does better. If your employer can be flexible with your activity at work you may be able to do some lighter duties or reduced hours from 3 weeks onward. If you work on your feet all day, do a manual job, or are required to wear dress shoes you may need 8 weeks before you are back at work.

Clear Advice About DVT

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A DVT is a Deep Vein Thrombosis or a blood clot in the leg. A blood clot occurs after surgery where patients are placed into plaster or a splint for about 2 in every 100 patients. You can help prevent a blood clot by keeping your knee moving. Keeping yourself hydrated is also helpful to prevent a DVT. Finally elevating your leg to the level of your heart will minimise the amount of swelling you have which will also help to prevent a DVT. You will be given blood thinners for the first two weeks when you at your least active.

 

If you were to develop a DVT you would likely have some symptoms and so it is very helpful if know what to look for:

  • The leg (above the dressing/foot) would become hard, heavy, swollen, painful and/or red

  • If you were to have any of the above symptoms you would have to have a scan to look for a blood clot and then be treated with blood thinners

If the blood clot were to move to the lungs you would have a pulmonary embolism which is a medical emergency

  • The symptoms of a pulmonary embolism are breathless & chest pain- Call 911

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The Recovery after Broström Lateral Ligament Repair

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Instructions for the first two weeks

  1. Elevate Leg Above Heart

  2. Keep dry for two weeks

  3. Keep dressing intact

  4. Please remember that the more time spent standing or walking, the more swollen your foot will be and the worse your healing will be

  5. Partial Weight bear with the aid of crutches in the air cast boot.

  6. You make take the boot off at night and to do your physiotherapy

  7. Physio Exercises: Get your ankle moving! Do the following every waking hour 10-15 times

A)  Alternate the ankle between dorsiflexion and plantarflexion

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B) Alternate the ankle between inversion and eversion

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C) Draw the Alphabet with your big toe. This will encourage the ankle to move in all directions.

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D) Seated Calf Raise

  1. Sit in a chair

  2. Lift your heel as far as possible while keeping your toes on the floor.

  3. Repeat 10 x

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AT 2 WEEKS

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  • I will arrange to have your sutures removed and to check your wound

  • You will then be able to wash the ankle

  • You should schedule your first physiotherapy session for 2 weeks

 

PHYSIOTHERAPY 2-6 WKS

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  • You must continue to use the airrcast boot to stand and walk

  • Continue to work on range of motion but progress to towel or standing stretches

  • Contrast bathing,

  • Wound massage (self) for 3 months

  • Local modalities to reduce swelling

  • Start to work on strengthening

    • Theraband Resistance

    • Cycling on stationary cycle

    • Progressing to double heel rises

    • Swimming, Hydrotherapy

  • Start some early proprioception (balance) work by standing on skipping rope to create a slightly uneven surface

  • Progress to the Surrey Stages to Strengthen Ankle

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AT 6 WEEKS

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  • I will check your progress in clinic

  • If possible I will let you switch to an Ankle Stirrup Brace

  • I will check your progress with the 'Surrey Stages' Rehabilitation Program

THE ‘SURREY STAGES’ PHYSIOTHERAPY STRENGTHENING PROGRAM

 

BRONZE AWARD

DOUBLE HEEL RISES (DHR)

  • You can go up and down on tiptoes in sets of 3, slowly and 15 reps in each

  • You can stand on a skipping rope and adjust your foot position

  • You can hold a DHR for 15 seconds

  • It can be difficult to progress to the next award level because the ankle will take double the weight when you move to lifting the good leg to lower only on the operated leg.

  • You are better to stay at the bronze award level but to add in a back pack with increasing weight as you feel ready for more

  • When you have done this for some time you will be ready to progress to the silver award level

 

SILVER AWARD

DOUBLE HEEL RISES WITH A LIFT

  • May need to add weight in backpack on DHR to reach silver level

  • You go up on both feet but lift unoperated leg and lower slowly only on operated leg

  • 3 sets, working up to 15 reps in each

  • You can stand both feet on a wobble board

  • You can hold a solid DHR for 20 seconds

 

GOLD AWARD

SINGLE HEEL RISES

  • 3 sets, working up to 15 reps in each

  • You can stand on one foot on wobble board

  • You can hold a solid DHR for 40+ seconds

 

PLATINUM AWARD

  • Progress to hopping in all directions

  • Double Hops

  • Gentle jogging to reintroduce running

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