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Ankle injuries are one of the commonest injuries due to twisting of ankle. Tear of lateral ligament of ankle (ATLF and calcaneofibular in isolation or both) is a relatively common injuries. Around 60-70% heal well with nonoperative treatment for 6-12 weaks including cast immobilization and/or physiotherapy. The remaining one do not heal and cause a continuous dyscomfort and disability to the patient.
The diagnosis is made firstly on the basis of clinical examination by the expert including the anterior drawer test being positive. The imaging modalities like stress X rays and MRI confirm the diagnosis.
Once the diagnosis is confirmed, the treatment is usually surgical. In surgery, first ankle arthroscopy should be performed to rule out any intraarticular associated pathologies which are usually there in around 20% cases of ankle ligament injuries. After the ankle arthroscopy, through a tiny incision, the fibrosed and scarred ATLF is dissected and repaired in a double breasting fashion. Most of the times this simple method of double breasting is possible, but rarely the surgeon may have to use a bone anchor to repair the ATLF.
To strengthen the repair, the Gould modification of adding the extensor retinaculum ( a relatively strong tissue lying near to the ATLF) is used to add another layer of strength over the repair.
The patient is usually given a cast immobilzation for 6 weeks after the surgery. During this period, the sutures are removed after 2 weeks of surgery. After 6 weeks of immobiliozation, patient is motivated and encouraged to start with full weight on the operated foot. The patients are usually able to walk normally in the next 2-4 weeks.
The patients are allowed full sporting activiies of running/ jumping etc after 6 months of surgery.