Ankle Sprain Repair: High Ankle Sprain

The 26 Review

  • What is a High Ankle Sprain Repair Stabilization of the syndesmotic joint between the tibia and fibula
  • How A suture button is used to connect the tibia and fibula through a minimally invasive procedure.
  • Why To stabilize the ankle and leg for normal gait
  • Recommended for Patients experiencing pain, swelling, and difficulty walking, bearing weight, flexing the ankle, and climbing up or down stairs 
  • Length of Treatment Surgery takes 1-2 hours to perform, depending on the severity of the case.
  • Downtime 2-3 months for recovery

Let’s take a closer look…

A high ankle sprain or ankle syndesmotic ligament tear occurs at the point just above the ankle. The two bones in the lower leg are the tibia and fibula and where these two bones meet is called the syndesmosis. While technically a joint, the syndesmosis doesn’t function like most joints seeing as there is very little motion between the two bones. However, the syndesmosis is still very important because its main function is to provide stability for the ankle joint and allow the joint to move. The most common way to injure the syndesmosis is from twisting or rotational injuries, generally from sports like football, hockey, and rugby. When this injury occurs, the syndesmosis is stretched or torn. While not all cases of a high ankle sprain require surgery, if left untreated, patients can develop arthritis or be more prone to ankle disabilities. The main goal of surgery is to properly align and stabilize the joint so that the ligaments can heal into the correct position. This ailment is commonly diagnosed through physical examinations, X-rays, CT-scans, and MRIs.

Procedure Details: Pre, During & Post Surgery Expectations

To prepare for high ankle sprain surgery, speak with your medical provider for a personalized plan. In most cases, individuals will be asked to halt medications like anti-inflammatories and blood thinners. Patients may also be asked to stop smoking 2 weeks prior to the procedure, in order to help prevent infection. It is important to tell your healthcare provider about all medications you’re taking, as well as any changes in your overall health, like a recent fever. Before the procedure, advanced imaging tests like X-rays, CT-scans, and/or MRIs will be performed. Patients should not eat or drink anything 6-8 hours before the procedure. In addition, this is an outpatient procedure, so it’s critical to make a plan for returning home, as well as how you’ll get around your home.

Prior to beginning the surgery, patients will be administered spinal or general anesthesia, with a possible nerve block. The surgical procedure for repairing a high ankle sprain with an unstable syndesmosis is referred to as an open reduction with internal fixation. During this procedure, the medical professional will aim to restore the original alignment of the bones, ligaments, and joints by using surgical hardware to hold them in place. Seeing as the syndesmosis can’t simply be repaired with suturing the ligaments together, the fibula and tibia are stabilized together to allow the syndesmosis to heal properly. Typically, the surgical hardware utilized is a suture button. A suture button is a medical device used to stabilize the syndesmosis after injury, allowing for flexible fixation and an improvement over previously rigid forms of fixation. A suture button device provides fixation of syndesmosis injuries regardless of whether a compound fracture is present or not. The suture button consists of a fiber thread attached between 2 metal buttons. 

After the open reduction with internal fixation surgery is over, the patient will be placed in a non-removable splint or cast. The cast must be worn for a period of at least 6 weeks, in conjunction with crutches or a walker to limit weight bearing on the affected area. Patients can elect to use a knee scooter in place of crutches. After 6 to 8 weeks have passed, patients can return to have their splint or cast removed, in which the ankle will be reimaged to ensure the ligaments are healing properly. Patients will then be administered a removable walking cast and required to begin physical therapy, in order to recover strength, stability, and mobility in the ankle. 6 months after surgery, most patients are fully healed, however full recovery can take up to 1 year. 

Benefits and Risk Factors

As stated, the goal of this procedure is to stabilize the syndesmosis without eliminating normal motion. The main benefits of this procedure include restoring the alignment and stability of the ankle, regaining pre-injury function, and reducing the risks for developing future ailments or injuries. Like most surgeries, there are significant complications that can occur, so it is important to speak with a podiatrist prior to surgery. Those risks include arthritis, chronic pain, stiffness, loss of function, chronic swelling, infection, and nerve damage. While these risks are unlikely to occur, it is still crucial to stay informed. The suture button fixation offers a few benefits for syndesmosis stabilization. Those benefits can include better ankle motion, decreased stiffness, and decreased discomfort compared to alternative fixations. The suture button also focuses on complication reduction by the minimally invasive nature of the procedure. While both options offer great benefits, there can be risks as well. If you or someone you know is battling a high ankle sprain that may require surgery, speak with your Board Certified Podiatrist for a personalized treatment plan. 

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