As mentioned before, the overwhelming majority of ankle sprains will get better with conservative care in 2-3 months. Once x-rays have confirmed there isn’t any fracture, most sprains get better with R.I.C.E., as well as bracing and protection. However, there are some people who will continue to have pain and discomfort despite our best efforts. The decision to go ahead with surgery is one that is complicated. Both the patient and doctor will have to discuss and agree upon a plan as a team. Let’s discuss some options.
One attractive option is to do ankle arthroscopy. Similar to what is done in the knee, a small fiber-optic camera is inserted into the ankle joint along with a tool to remove any loose particles inside the ankle joint. With multiple ankle sprains, pieces of bone, cartilage, or inflamed ligaments can impinge on the ankle joint. Once loose particles are removed, pain is lessened and improvement is seen. The main advantage to ankle arthroscopy is that there are only 2 small incisions made where the instruments are inserted. The incisions heal quickly and downtime is usually 10 days to 2 weeks.
Another procedure that can be done is called a Brostrom procedure. As we discussed, ankle sprains can cause ligaments to tear. The Brostrom procedure attempts to sew back together a ligament that is often torn in ankle sprains. It is sewn together with a very strong suture material, so that stability is gained and pain is minimized. This procedure requires a longer healing period as the ligament fiber ends need to reconnect.
In some cases, torn ligaments are so bad that it is impossible to sow them back together. In these cases, grafts can be used. There are many variations to what can be done to recreate the ligaments. The doctor can use a graft made from bovine or porcine sources, or harvest tendon from another source in the body. Depending on which ligaments are torn, the doctor can adjust what he uses to restore stability.
There are additional procedures that exist to help a persistent ankle sprain. Work with your doctor to decide which procedure best fits your situation.