Ankle Surgery & Rehab

Question 1

What are the issues associated with ATFL reconstruction?

Answer 1

• Surgical vs conservative
• Surgical only if conservative has failed
• Surgery slower to recover, outcomes not much better

Question 2

What are the indications for ankle reconstruction?

Answer 2

• Persistent stiffness, swelling & pain
• Delayed synovitis, tendonitis & weakness
• Instability/giving way
• Grade III tears, clinical tests, stress X-ray, MRI
• Patient’s subjective feeling of not coping

Question 3

What are the consequences of not having an ankle reconstruction when it is indicated?

Answer 3

• Problems with sport

- Late joint OA

Question 4

What does a Brostrom ankle reconstruction involve?

Answer 4

Direct suturing of torn ligaments, imprecation, reinsertion into bone

Question 5

What are the benefits of a Brostrom?

Answer 5

• Requires less exposure
• Maintains full ankle motion
• Simple & reliable
• Avoids use of donor tendons

Question 6

What is used for ankle tendon graft reconstruction?

Answer 6

LARS ligament

Question 7

When is a LARS ligament most effective?

Answer 7

When there are remnants of the original ligaments

Question 8

What are common restrictions post ankle reconstruction?

Answer 8

• AROM/PROM
• ROM limits
• Weight bearing status

Question 9

What are the issues that complicate ankles?

Answer 9

• Calf strength (gastroc, PF)

- DF ROM

Question 10

What is the protocol for ankle rehab in a short leg cast?

Answer 10

• Cast change at 1-2 weeks
• WB starts 3 weeks
• Direct physio starts 6 weeks

Question 11

What are the indications for ankle ORIF?

Answer 11

• Talar tilt 5mm on stress radiographic view
• Talus sublimed forward/backward beneath tibial plafond
• Posterior malleolar fracture with >25% joint involvement or >2mm shift in articular surface

Question 12

What are the types of ankle ORIF?

Answer 12

• Type A: Closed reduction, intramedullary nail or compression plating
• Type B: Open reduction, buttress plate & lag screws or temporary joint bridge & external fixation

Question 13

What are the post op rehab guidelines for ankle ORIF?

Answer 13

• Short-leg cast in neutral position
• Elevate as much as possible
• Day surgery or 1-2 night stay
• NWB on crutches for at least 4 weeks
• 4 weeks PWB
• Gradual increase to FWB

Question 14

What are the ankle ORIF rehab guidelines once the fracture has healed?

Answer 14

• Supportive brace

- Start pool then land physical therapy

Question 15

What are the indications for ankle arthroscopy?

Answer 15

• Loose bodies
• Anterior tibiotalar osteophytes
• Soft tissue impingement
• Osteochondral lesions
• Synovectomy
• Lateral instability
• Arthrodesis
• Ankle fractures

Question 16

What are the benefits of ankle arthroscopy?

Answer 16

• Less invasive
• Less trauma to structures
• More activity early post op

Question 17

What are the 6 basic principles when planning ankle rehab protocol?

Answer 17

• Protect healing tissue
• Control acute symptoms & restore normalised mobility
• Minimise effects of immobilisation
• Encourage neutral subtler position during exercise
• Optimise function
• Take into account whole patient (kinetic chain)