What is Involved in Ankle Sprain Surgery?

Though rare, ankle sprain surgery might be performed when one has injured an ankle and the injury does not respond to nonsurgical treatment. In some cases, the surgery might be performed immediately if the sprain has torn the lateral ankle ligament. The two most common forms of ankle sprain surgery are ligament tightening and tendon grafting. Ankle sprain surgery typically involves cutting certain ligaments or tendons and either reconnecting them elsewhere or replacing them altogether. There usually is a period of rehabilitation after the surgery as well, to help the patient regain full use of the ankle.

If a sprain causes chronic ankle instability — an ankle that frequently gives out because of the stretching or tearing of the lateral ankle ligament — then ligament-tightening surgery is an option for correcting the damage. This type of ankle sprain surgery involves cutting the anterior talo-fibular ligament (ATFL) and the calcaneo-fibular ligament (CFL). After being cut, the two ligaments are sewn together and attached to a hole that has been drilled into the fibula, one of the bones of the lower leg. A collection of connective tissues that keep the ankle tendons in place called the ankle retinaculum is stretched and sewn to the fibula, with the aim of strengthening the newly tightened ATFL and CFL.

Tendon graft ankle sprain surgery is a more involved procedure that is performed when the ankle ligaments have been damaged beyond repair. This procedure involves cutting a piece of a nearby tendon — usually the peroneus brevis of the small toe — and replacing it with the torn ligaments of the ankle. To attach the grafted tendon, a hole is drilled in the fibula, and another is drilled in the anklebone. After the holes have been made, the crafted tendon is sewn between them to create a new ligament complex.

Both forms of ankle sprain surgery are major surgery and require intensive rehabilitation. Someone who undergoes either surgery typically will have his or her ankle wrapped in a supportive brace or cast, and physical therapy will be required. The first phase of therapy likely will involve massage and electrical stimulation to help the patient manage the pain and swelling that are experienced after surgery. After the pain and swelling become manageable, the patient will be subjected to simple exercises to help him or her regain movement in the affected area. In about the sixth week after surgery, the patient will begin more strenuous exercises to strengthen the ligaments, helping him or her learn to control movement in the ankle and walk.