When is surgery required for a torn ankle ligament?

Surgery for a torn ankle ligament would be considered in patients who either have persistent pain, and/ or instability.

We usually try conservative management for a torn ligament first, and if symptoms persist, and do not get better after 6 months, patients should consider a surgical option.

This is also important if a patient is young, has symptoms of early post-traumatic osteoarthritis, and is a high demand patient. This could mean high demand in terms of sporting, or just normal day to day activity.

It would also be prudent to consider a repeat MRI if the last scan was done some time back. So that the proper and appropriate surgical option can be planned.

Best regards

Dr Sean Ng

Here's a previous similar question on ankle sprains and treatment options that I answered.

I thought I would provide you with a little more.

In your case I would consider the following:

1. Consult a Sports/MSK physician who can assess, scan and treat your ankle appropriately

2. Consult a physiotherapist for rehabilitation

3. Consult a podiatrist for rehabilitation or consideration of orthoses

With all three, there are many options that you can consider before more surgical treatments.

Best of luck with your ankle.

BW

Dr Dinesh

Typically, ATFL ligament tear do not give rise to pain/ swelling after 9 months (of course it's painful like hell during the initial injury), so this persistent pain/ swelling that is bothering you is definitely not normal. I am sorry that this injury caused you to give up your hobbies of jogging and sports.

Doctors will need to take a detailed clinical history, review your previous X rays/ scans and a thorough physical examination to find out what is the cause of the persistent pain and swelling.

Some of the common causes of persistent pain after ankle sprain would include:

1. Osteochondral defect of the talus bone - the bone/ cartilage is directly injured during the sprain itself.

2. Anterior impingement syndrome - the scan tissue of the healed ligaments sometimes could be too "bulky" and causing abnormal friction in the ankle joint.

3. High ankle sprain - your previous ankle sprain might have damage more than just the ATFL ligament, it might have also damaged the inter-osseous ligament connecting the tibia and fibula.

4. Non-union of the fracture

Most likely we will need to do a MRI to find out exactly what's the cause of your persistent ankle pain and swelling and then we can target our treatment and help you to become active again.

ATFL reconstruction alone is usually indicated when the patients having recurrent ankle sprain despite adequate rehabilitation. Their main symptoms is actually INSTABILITY (recurrent sprain sometimes even walking on flat surfaces), rather than pain and swelling.

Hope it clear some doubts for you. Best Regards,

Dr. Henry Chan