Minimally invasive surgical options for torn ligament

Q: If I have a torn ligament in my ankle, what are the minimally invasive options that I can consider? How long is the post-surgery recovery and do I need to undergo any rehabilitation programme? Will I still be able to do high-impact sports and activities after the surgery?

A: There are two minimally invasive options you may consider, namely arthroscopic and mini-incision surgery.

In arthroscopic surgery - also known as keyhole surgery - a camera is introduced through a small incision, measuring less than 1cm, for visualisation during surgery.

Working instruments to repair your ankle ligament are then inserted through similarly sized but separate incisions. The number of incisions needed depends on the complexity of the surgery but usually just two to three skin incisions are all that are necessary.

Mini-incision surgery, on the other hand, is a technical advancement over previous open surgery techniques. Here, there is no need for a camera system to be inserted into the body as this is an open surgical technique. Typically, mini incisions measuring 2cm to 3cm in length are made instead of long incisions. Extensive soft tissue dissection is also avoided.

A full return to recreational sports is typically achieved at six months after the surgery and competitive-level sports, around nine months. Post-operative rehabilitation is crucial for a good outcome.

In both techniques, the aim is to minimise the surgical trauma to the body's tissues. The main advantages of minimally invasive techniques are less post-operative pain, faster post-operative recovery and smaller scars. Deciding which technique to go for depends on the nature of your ligament tear and the proposed surgery.

Some procedures can be performed well through arthroscopic technique, while others are better done through mini-incision.

The duration of post-surgery recovery depends on the nature and extent of your ligament tear as well as the procedure performed.

For example, a repair of a partial tear will heal faster than a reconstructive procedure for a complete and chronic retracted tear.

Ligaments are like rubber bands and if they are completely torn, their ends will retract away like a snapped rubber band.

Over time, those retracted tear ends scar down and are difficult to bring together for direct surgical repair. Most of these chronic, retracted tears require more complicated reconstruction, for example, surrounding tendons may be used to replace the torn ligament.

Generally, ligaments take longer than bones to heal. This is because they do not have the same generous blood supply as the bone.

Depending on the stability of your repair or reconstruction, you may have to take protective measures to avoid weight-bearing on the affected area, such as by using crutches or wearing a cast or a removable boot. This is usually recommended for six weeks after the procedure. It usually takes four to six months for a person to make a full recovery.

A full return to recreational sports is typically achieved at six months after the surgery and competitive-level sports, around nine months. Post-operative rehabilitation is crucial for a good outcome.

You will be working closely and regularly with a physiotherapist to build up your proprioception.

Proprioception is critical for a person to regain good ankle, foot and gait function. It refers to the neurological input and feedback loop between the ankle and brain which in turn allows the body to respond appropriately to various ankle positions and movements.

That said, most patients are able to return to high-impact sports and activities eventually. For certain high-risk or physically demanding sports, wearing an ankle support may be advised to protect your ankle ligament from tearing again.

DR LEON FOO
Orthopaedic surgeon at Mount Elizabeth Hospital

A version of this article appeared in the print edition of The Straits Times on August 04, 2015, with the headline 'Minimally invasive surgical options for torn ligament'. Print Edition | Subscribe