Operative therapy for ligament injuriesOctober 20, 2021
In the case of fresh external ligament ruptures, also nowadays agree that with a three-ligament lesion, i.e. rupture of all three ligaments, especially the posterior fibulotalar ligament, the chances of success through surgical treatment of such a severe instability are better.
Personal experience with severe twisting trauma and external ligament ruptures in professional athletes, lateral ankle ligament reconstruction shows that an additional arthroscopic irrigation in addition to the surgical treatment leads to faster healing. On the one hand, because the bruise is completely removed from the joint and, on the other hand, the entire joint can be viewed without problems in this examination in order to identify and treat potential cartilage damage.
The follow-up treatment after fresh, operative external ligament ruptures corresponds to the conservative functional treatment after wound healing, the treatment in an orthosis, e.g. Aircast splint and plaster-free. Further follow-up treatment starts on the 5th / 6th. Week before training the peroneal muscles, which always suffer from this type of injury, as well as proprioceptive training (wobble board, etc.), in order to achieve a good reaction of the muscles again when the position of the joint changes.
There are 2 options for anatomical reconstruction:
- Reconstruction according to CarlssonIn this operation, the structure of the ligaments is still relatively well preserved but loosened overall so that they can be pulled back into the bone. In addition, the joint capsule, which has also expanded due to the constant twisting, can then be gathered again.
- Periosteal flap in the second option, the joint structures are so reduced by the constant twisting that a local reconstruction is not possible. To restore a new ligament, periosteum of the fibula is prepared accordingly so that a new outer ligament can be anatomically reconstructed.The follow-up treatment consists of putting on a cast for 14 days. With good, stable reconstructions, an orthosis can then be used.
In rare cases, instability in the area of the so-called delta band on the inside of the foot can occur.The delta band is divided into 2 layers – a deep layer and a surface layer. In this technically demanding operation, the individual ribbons have to be gathered.
The main problem for patients is the feeling of bending inwards and having pain in the middle part of the ankle. After the operation, a plaster treatment is carried out for 6 weeks. Then a physiotherapy exercise program.The injury occurs primarily in high-performance athletes.In individual cases it can also be the result of an ankle trauma.