Ankle Adhesions and Lateral Collateral Ligament Reconstruction

Ankle joint adhesion and the transplantation method of the lateral collateral ligament of the knee joint?

Dear Dr.
Shi,
Two years ago, I was involved in a car accident abroad that injured my left lower limb.
Following surgery, I developed an infection, which led to a flap and skin grafting from 10 centimeters above the ankle joint to the knee joint on the inner side of my calf.
My tibia was not injured, but the upper end of my fibula is missing, resulting in a torn lateral collateral ligament of the knee.
To date, I have been unable to achieve 90 degrees of motion in my ankle joint, while my knee joint has reached 120 degrees.
I have been a patient for two years now.
This week, on October 13, I underwent an Achilles tendon lengthening procedure.
The following day, my doctor informed me that it was unsuccessful because my ankle joint has become adhesed and cannot return to its normal angle (initially, the doctor believed that simply relaxing the Achilles tendon would suffice).

I would like to ask you the following questions:
1.
Are there any instruments available to assess the adhesions in my ankle joint?
2.
Given that my ankle joint has been immobile for an extended period (due to six months of foot drop), would it be possible to perform arthroscopy or use shockwave therapy to address the adhesions effectively?
3.
If such procedures are viable, would I be suitable for them immediately? Currently, my foot is in a cast, and the doctor mentioned that I must wait three months before it can be removed for rehabilitation.
I would like to know if I could potentially save time and avoid additional rehabilitation later.
4.
Is it necessary for the Achilles tendon lengthening procedure to require a cast for such an extended period?
5.
What surgical options are available for my lateral collateral ligament of the knee? Given my current condition, when do you think would be the most appropriate time to proceed with surgery? (Due to poor circulation in my foot, I have persistent bruising and have not been able to wear a knee brace.)
I am an urgent patient in need of your insights.

frank, 30~39 year old female. Ask Date: 2003/10/19

Dr. Shi Guozheng reply Orthopedics

Ankle joint adhesions can be diagnosed through arthroscopic examination, which can also be used to perform adhesiolysis.
However, since your joint issue has been longstanding, the effectiveness of the procedure is uncertain, but it may be worth trying.
After Achilles tendon reconstruction, immobilization should last about six to eight weeks, but protection should be maintained for up to twelve weeks.
The duration of splinting must be discussed with your physician.
Surgery on the lateral collateral ligament of the knee must be determined after evaluation by a physician.

Reply Date: 2003/10/19

More Info

Understanding ankle adhesions and lateral collateral ligament reconstruction is crucial for anyone who has undergone significant lower limb trauma, especially in the context of your situation. It sounds like you have been through a lot, and I appreciate your patience as you navigate your recovery.

1. Detection of Ankle Adhesions: There are several imaging modalities that can help assess the condition of your ankle joint and the presence of adhesions. MRI (Magnetic Resonance Imaging) is particularly useful as it provides detailed images of soft tissues, including ligaments and tendons. It can help visualize any abnormal scarring or adhesions around the ankle joint. Ultrasound is another option that can be used to assess soft tissue structures in real-time, allowing for dynamic evaluation of the joint. However, the definitive diagnosis of adhesions often comes from a combination of imaging studies and clinical examination.

2. Surgical Options for Adhesions: If your ankle joint has developed adhesions due to prolonged immobility, arthroscopic surgery (ankle arthroscopy) may be a viable option. This minimally invasive procedure allows surgeons to visualize the joint and remove any scar tissue that may be limiting your range of motion. Additionally, shockwave therapy (extracorporeal shock wave therapy) has been explored as a non-invasive treatment to promote healing and reduce pain, although its effectiveness can vary. It's essential to discuss these options with your orthopedic surgeon, as they can provide tailored recommendations based on your specific condition.

3. Timing for Surgery: Given that your ankle is currently in a cast for three months post-Achilles tendon lengthening, it is crucial to allow adequate time for healing before considering any additional surgical interventions. Performing surgery too soon could compromise the healing of the Achilles tendon and lead to complications. After the cast is removed, a thorough evaluation of your ankle's range of motion and function will be necessary to determine the best course of action.

4. Duration of Casting Post-Achilles Tendon Lengthening: The duration of casting after an Achilles tendon lengthening procedure can vary based on the surgeon's protocol and your individual healing process. Typically, a cast is used for several weeks to protect the tendon as it heals. Your surgeon will provide specific guidelines on when it is safe to begin rehabilitation exercises.

5. Reconstruction of the Lateral Collateral Ligament: For the lateral collateral ligament (LCL) of the knee, surgical options include direct repair if the ligament is still intact but torn, or reconstruction using a graft if the ligament is completely ruptured. The choice of procedure often depends on the extent of the injury and the presence of other knee injuries. Given your history of poor circulation and bruising, it is essential to ensure that any surgical intervention is timed appropriately to minimize risks and optimize healing.

In summary, while your situation is complex, there are potential avenues for treatment and rehabilitation. It is vital to maintain open communication with your healthcare team, as they can provide personalized advice based on your recovery progress and overall health status. Your journey may be challenging, but with the right support and interventions, there is hope for improved function and quality of life.

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