Ankle sprains are some of the most common injuries in sports. When they occur low down by the bony protuberances (“malleoli”) on either the outside or the inside of the ankle, they are generally treated symptomatically until the athlete is able to return to competition. When they sprain occurs higher up between the two leg bones (tibia and fibula), the sprain takes much longer to heal and often requires surgery.
In this instance, the tibia and fibula dissociate from each other and the articular surfaces of the ankle joint are often no longer congruent, setting the stage for post-traumatic arthritis. The goal of surgery is to make the joint surfaces congruent again (or “anatomic”) as they were before the injury so the ankle is stable and the joint surfaces glide on one another perfectly.
While low ankle sprains generally take anywhere from a few days to a few weeks to recover from, the dreaded “High Ankle Sprain” can sometimes take months to return to competitive sport.
The surgical treatment for these injuries has evolved along with all of sports medicine, so that now, instead of screws, I routinely use an implantable device called a “tightrope." It holds the two bones together much like the cable a trapeze artist walks on at circuses.
In contrast to traditional screws used to fix high ankle sprains, the tight rope allows for a little bit of physiologic motion between the fibula and tibia that occurs naturally. Research has shown the tightrope construct provides a more anatomic reduction than screws, and I believe the physiologic motion allowed by the tight rope allows more anatomic movement during ankle motion.
Another advantage of this tightrope system is there is no risk of implant breakage, which often happens with screws once the athlete returns to play. Therefore, hardware removal is unnecessary with the tight rope construct and a second surgery (which is required to remove the screws once the high ankle sprain is healed) is avoided.
See the images below to see what the x-rays look like following ankle tightrope surgery for a high ankle sprain.
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