MedClinic > Blog > Traumatology > Chronic external instability of the ankle

Damage to the ligaments of ankle joint is a fairly common injury. Most often, the injury occurs in winter when slipping the foot on ice, icy steps and platforms. It is possible to damage ankle while playing sports, but not only – often an injury can happen to you at home – for example, by stumbling or twisting your leg, going down the stairs you can also injure the ligaments of the foot and ankle.

The ligaments provide not only stability of ankle joint and other joints of the foot, but it also protects ankle joint from external influences and non-physiological movements, especially twisting and rotational.

In most cases, damaged external lateral ligaments of ankle joint are restored with a good functional result. However, with severe damage or with frequent injuries, restoration of the ligaments structures may not occur. In this case, chronic external (lateral) joint instability develops.

Rupture of external lateral ligaments of ankle joint

According to studies, chronic external instability of the ankle joint develops in 20% of patients after acute rupture of ligaments. In this condition, patients complain of frequent episodes of spraining of the foot, especially when walking on rough terrain, feeling of instability, pain under the outer ankle occur. There is a feeling of fear of the possibility of another “dislocation” of the foot. X-ray signs of progressive deforming arthrosis of ankle joint may appear. Young active patients are forced to change their lifestyle and leave the sport.

Several clinical tests help identify this pathology:

– Front retraction test – patient sits with his legs hanging, the researcher’s hand is on the front surface of the lower third of the lower leg resisting the attempt to move the foot forward. Radiographs of both ankle joints in lateral projection are performed. With increased distance in the posterior joint, the test is considered positive.

Positive front retraction test

– test of lateral displacement (tilt) of talus – patient sits with his legs hanging, the foot in the neutral position is advanced anteriorly and then it is given a position of strong inversion (deflection of the foot inward). With a positive test, an excess tilt of the talus inside is noted.

Positive lateral displacement test

In radiography in standard projections, calcifications can be noted located distal to the lateral ankle, which is a sign of chronic damage to the ligaments of the external ankle joint. On the lateral or medial edge of the talus, concomitant osteochondral lesions can be detected.

The presence of chronic lateral instability of the ankle joint is an indication for surgical treatment. Ligament integrity is restored surgically – by suturing or moving other ligaments and strengthening the ankle joint using arthroscopic techniques.

ArthroBrostrom external lateral ligament repair technique

The choice of joint stabilization method should start from simple to more complex and reconstructive. Therefore, at the first stage, restorative operations using local tissues should be preferred (the Brostrom operation).

In young patients, plastic surgery of lateral zone is performed with special threads using special fixators (anchors).

It is advisable to leave reconstructive options using tendon plastic surgery for cases of generalized weakness of the ligaments and repeated operations for relapses of instability.

Plastic surgery technique on the external lateral ligaments of the ankle joint