Lateral ankle ligament instability and reconstruction.
So basically, there are three ankle ligaments on this side. You have one, two and three.
That’s not exactly anatomical but there’s one that goes here, one that goes here and
one that fans out in the back. So there's three.
Typically, people injure this one and the middle one, the back one people hardly injure,
it’s very rare. So with you, you had two ankle ligament injuries. So what I did was
-- this is also a revision surgery too, I had to take out some old fixation that was causing
the wound to be open. The wound is closed now, so we’re good. We’re two weeks out,
everything looks great, sutures are still in, the wound that was present for four months
now has actually closed up within two weeks, so this is great.
Now we go over the procedure that was done. Typically, if it was not a revision case,
sometimes if there’s an ankle ligament, if we can find that in there, most of the time it’s
actually gone, we can’t find it. But we can-- a lot of times I just tie these together.
But, the majority of the time what is done is that there’s a little piece of tissue
right here on this that’s holding all the tendons down on the top of the foot right
about here, right about this area. That is the ankle ligament we attempt to reconstruct.
So what I do is, I take this ligament here, make you a couple of new ankle ligaments by tying
this to the bone. And that’s all done without anchor, that’s all done with a suture.
But in your case, because you had a bad reaction to a non-absorbable suture in your ankle that
kept your wound open for about four months, I used an absorbable one that is not very
reactive to you. It still does the job of reconstructing the ankle ligament, as well
as putting an amniotic graft. An amniotic tissue graft helps to form your ankle ligament.
It’s almost like a pluripotent stem cell. It goes and adapts to whatever I put it on.
So that’s why your wound is closed, that’s why you’re having the results that you’re
having and we’ll continue on the same track.
So basically I made you a new ankle ligament, I put a graft on there to enforce that and
now your ankle looks very stable to me. And how much pain do you have?
Patient: I have none right now.
Dr. Lam: How is pain after surgery?
Patient: A little bit after for the weekend, but not that bad.
Dr. Lam: So, this ankle -- lateral ankle ligament reconstruction is very easy. It’s actually
not very hard at all. We don’t have to get too fancy with ankles or what not… a lot
of times I can just do is I transfer your own ligament. Again, it’s this ligament
right up here, for the camera’s sake you get to see that, this ankle ligament.
This is the usual rupture ligament: anterior talofibular ligament, so this is already here
by nature. It’s always here. So take a suture, take this and suture it on to the remaining
stump or to the bone of the fibula. That way I can reconstruct one ligament or I can reconstruct
two ankle ligaments with same exact structure without having to cause too much destruction
or adding too many things that will cause an adverse or a foreign body reaction in your body.
So that’s why we’ve had good results so far. That’s perfect.
Patient: Good.
Dr. Lam: Hopefully I answered all your questions on that.
Patient: Yes. But one question, where did they have the anchors?
Dr. Lam: Your anchor from the previous surgery was here…
Patient: In that bone?
Dr. Lam: In the bone. The reason why I don’t use anchors is because of that reason.
But that is a valid technique and it doesn’t work really well with some patients.
Patient: That wire was connected between the anchors?
Dr. Lam: Correct.
Patient: I see. And that what you removed was the wires.
Dr. Lam: I just went ahead and used your own ligaments to reconstruct so we don’t have
this kind of problem.
Patient: Perfect.
Dr. Lam: And as you can see you’re closed.
Patient: Yes, excellent.