As sports become more popular, so does the number of sports injuries. Most often, athletes injure the joints. Up to 20% of all injuries are ankle ligament injuries. They are often combined with ankle fractures. These injuries are not always diagnosed on time. 50% of patients do not receive timely medical care. If left untreated, chronic ankle instability develops. It worsens the quality of life and leads to mobility deterioration, up to a complete fusion of the articular surfaces.
- What ligaments can be ruptured
- Ankle ligament injuries
- Types of surgical treatment
- After surgery
- Why is it worth undergoing treatment in Germany?
What ligaments can be ruptured
The ligaments of the ankle, depending on their location, are divided into three groups: the medial ligament complex (deltoid ligament), the lateral ligament complex (lateral ankle ligament), and the tibiofibular junction ligaments.
The deltoid ligament is responsible for the stability of the internal ligamentous complex.
The ligaments of the lateral ligamentous complex are located outside the joint. The most important of these is the talofibular ligament. It prevents the extension of the foot and limits the posterior displacement and outward rotation of the talus.
The tibiofibular ligament fibers provide stability to the lower fibula and tibia by preventing outward repetition of the talus.
Ankle ligament injuries
The injuries of the ligamentous apparatus of the ankle joint are classified as severe injuries. According to their frequency, they are in second place after knee ligament rupture—however, the ankle experiences higher loads. The ankle joint holds almost the entire mass of the human body, and at the same time, has high mobility.
With an excessive sharp movement of the lower leg, it is not the ankle sprain that occurs but ruptures of varying severity: partial and complete. Together with them, the vessels are also torn, which leads to hemorrhage into the articular cavity.
The most common type of injury is distal tibiofibular junction rupture. It is often associated with a torn deltoid ligament and an ankle fracture.
Immediately after the injury, the main symptom is a pain in the ankle, but gradually it disappears. The main sign of chronic injury is a feeling of joint instability, which is associated with deteriorated proprioceptive sensitivity.
When turning the foot outward, the external ligaments are injured. The most common rupture is the anterior talofibular ligament. The calcaneofibular ligament is often affected as well.
Types of surgical treatment
The surgical treatment is provided using open or arthroscopic (minimally invasive) surgery. Although doctors in Germany prefer minimally traumatic methods of treatment, in some cases, open surgery is required.
The aim of the surgical intervention is to stabilize the joint. Doctors use anatomical and non-anatomical reconstruction options.
The main options for surgical treatment are as follows:
- anatomical reconstruction of the ligaments;
- transplantation from the peroneal tendon;
- static stabilization with tendon grafts.
Most often, doctors resort to the anatomical reconstruction of the ligaments. They restore the damaged structures using the patient's own tissues, donor, or artificial material.
The non-anatomical technique involves stabilization using tenodesis (mobility limitation) using the tendon of the peroneus Brevis muscle. These operations were developed in the middle of the 20th century. Subsequently, they were abandoned by most doctors due to poor long-term outcomes.
In 1966, the L. Brostrom procedure was developed. This is an anatomical reconstruction. In Western European countries, including Germany, this surgical intervention is still used as one of the main treatment methods. It completely restores ankle stability in 85% of cases. There have been developed some modified techniques that provide even better results. Some studies report up to 100% X-ray and clinical success.
The Chrisman-Snook procedure provides comparable results. It refers to non-anatomical reconstruction options. 93% of patients feel ankle stability after this type of treatment. But there are disadvantages: after surgery, the mobility of the joint decreases due to the significant tension of the reconstructed ligament. In addition, the surgical intervention is more traumatic.
Here are some plastic surgery options, depending on what material is used:
Autoplasty usually involves using the tendons of the muscles of the lower leg. This is the most common technique. The repaired ligaments are as strong as possible and are characterized by good engraftment. However, there is a minus: additional trauma to the donor site.
Synthetic ligament endoprostheses do not require additional trauma but are less reliable compared to the patient's own tissues. The risk of repeated rupture is higher, especially in those who play sports. In recent years, new materials have been used in German hospitals. The plastic repair with these materials provides results comparable to autoplasty.
Alloplasty is a donor tendon transplant surgery. It avoids trauma to the donor site, but preservation reduces the strength of the material.
Fresh injuries of the distal tibiofibular junction require osteosynthesis. Percutaneous techniques are applicable only in the first two months after injury. But in the future, external fixation devices can complement the surgical treatment for ligament reconstruction, as they allow keeping the foot in a functionally advantageous position.
The surgical access is made through a skin incision of about 5 cm. Doctors remove scars and remnants of the injured ankle ligaments. The second incision is made on the anterior-inner surface of the ankle and the lower third of the lower leg. The surgical needles are passed through two tibia bones, and the normal ratio of the tibia bones at the joint level is restored with their help. To restore the ligament over the ankle, bone canals are made. A tendon graft is passed through them. Its ends are stretched and sutured together. The sutures run along the inner surface of the tibia.
After the open surgery, the patient requires rehabilitation, which lasts several months.
Painkillers, colds, and physiotherapy are used for pain relief. Massage can also be used.
The ankle joint is immobilized. The immobilization period reaches two months. It depends on the nature, the severity of the injury, and the presence of a concomitant ankle fracture.
After the period of rigid immobilization is over, orthoses of a medium or light degree of fixation are used. They allow performing movements and starting rehabilitation activities.
The initial stage of recovery takes place in the same medical hospital where the patient received surgical treatment for the injury. Then he can continue treatment at a rehabilitation center. The main method of rehabilitation is therapeutic exercises. In Germany, exercises are selected individually for the patient, the results are monitored, and the training program is adjusted every week.
The objective of rehabilitation is to completely eliminate pain, restore ankle function, and a gradual return to maximum physical activity. The patient regains muscle volume, musculo-articular sensitivity, and a normal walking pattern.
Why is it worth undergoing treatment in Germany?
In case of an ankle ligament rupture, both fresh and old, you can contact one of the medical clinics in Germany. This country provides accurate diagnostic methods to detect ligament injuries, tibiofibular junction, ankle fractures, and other components of the injury. Doctors perform ankle surgery to relieve pain and chronic ankle instability. After treatment, you will be able to play sports again. The risk of repeated ligament and ankle injuries is minimized.
Why is it better to get treatment in Germany:
- experienced orthopedists specializing in sports medicine and traumatology, who have a high reputation throughout the world;
- sparing treatments for injuries of the ligaments, ankles, and tibiofibular junction;
- preference is given to the anatomical reconstruction options that allow doctors to fully restore ankle mobility;
- modified types of surgical procedures with efficiency up to 100%;
- low risk of complications;
- successful treatment of combined injuries with torn ligaments and ankle injuries;
- adequate anesthesia of surgical interventions and elimination of pain and other symptoms in the postoperative period;
- quality care and full rehabilitation from the first days after the surgery.
To undergo lateral ankle sprains treatment in Germany, please use the Booking Health service. On our website, you have the opportunity to get up-to-date and accurate information about the cost of treatment in Germany for ankle and ligament injuries, compare prices in different German hospitals and book a medical care program at a favorable price. The treatment will be easier and faster for you, and the cost of treatment in Germany will be lower.
You are welcome to leave your request on the Booking Health website. Our employee will contact you, consult, and answer all questions about the treatment of ligament and ankle injuries. We will take care of the organization of your trip abroad. We will provide the following benefits for you:
- We will select the best German hospital, whose doctors specialize in the surgical treatment of ankle sprains and achieve the best results.
- We will help overcome the language barrier and establish communication with the doctor of the German hospital.
- The waiting time for the treatment of your ankle injury will be reduced, and you will receive medical care on the most suitable dates.
- We will reduce the price. The cost of treatment in Germany will be lower than usual due to eliminating overpricing and coefficients for foreign patients.
- Our specialists will solve any organizational issues: paperwork, transfer from the airport to the German hospital and back, hotel booking, and interpreting services.
- We will prepare your documents and translate them into English or German. You do not have to repeat the previously performed diagnostic procedures.
- We will keep in contact with the German hospital after the treatment of the ankle injury.
- We will arrange additional diagnostics and treatment, if required.
- We will buy medicines in another country and forward them to your native country.
While the best specialists in the world take care of your ankles, the Booking Health staff will help you reduce the cost of treatment in Germany and take care of all the travel arrangements.
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!