Perspectives on Ankle Ligament Repair

I'm Tyson Green. I'm a podiatrist in Lake Charles, Louisiana. I run a large wound care center there and am a part of Center for Orthopedics, which is a large orthopedic group.

I think that when you're making that decision as to whether repair those ligaments or not, the instability is going to be inherently there after a pretty serious ankle ligament injury. So, whether to repair or not is always the question of acute versus chronic. Most of my practice are more chronic tears, unless I'm dealing with a high-level athlete that has instability, whether to repair it a certain way. That's always been the debate, whether open versus arthroscopic. And I think that the most recent literature has shown that it really doesn't matter how you repair it, whether arthroscopic or open as far as the results and the long-term results. There's different things from internal braces to using the patient's own body. And I think it, every situation has a different approach to that. So with ankle ligament repair, especially lateral ankle instability, that's something that we, it's not a cookie cutter approach. It's not a one size fits all approach. So we have to think through that and make sure that we're doing what's right for the individual patient rather than giving an algorithm saying, this is what you should do every time.

I do both open and arthroscopic, I prefer the open approach to be honest with you. Most of the time when I do it arthroscopically, I still feel like I need to open up and, and at least reinforce that in that area. I think I'm a little bit different on, on other people that, you know, have a certain approach that they do every time. I think it's individualized for the patient. There's sometimes where I don't need to use any type of internal braces or things like that. And there's sometimes with certain types of athletes, um, high level college athletes that I work with, I'm absolutely going to use an internal brace. So I think it's just different for every patient.

I think that there's a big push for early weightbearing and things like that. I think that we've kind of proven that it doesn't matter how you fix it. So, aftercare, we need to look at that. I think that a lot of people try to keep their patients really immobile for a long period of time. And with those types of procedures that could be really detrimental to the patient's long-term outcome. So I would rather mobilize them pretty early. Doesn't mean go tell them to, run on it in two weeks. I'm not trying to say that, but I will usually recommend non-weight-bearing for two weeks and then I'll start mobilizing them almost immediately. I'll put them in a boot, I'll start physical therapy. You must get that range of motion back immediately, or they will stiffen up so much on you where the instability is fixed, but else is so tight and it takes a long time. So with a, with a high-level athlete, especially, you don't want to take away that mobility on them.