Reconstructing an Ankle with No Remaining Ligament

From Instability to Stability: Reconstructing an Ankle with No Remaining Ligament

By Dr. Diego — Orthopedic Surgeon, Family Medical Practice Vietnam

A female patient in her 40s recently came to Family Medical Practice with a long history of repeated ankle sprains and a persistent feeling that her ankle could give way without warning. Over time, what began as occasional injuries had progressed into a chronic condition that affected her daily movement, confidence, and overall quality of life.

On further assessment, her case was found to be more severe than a typical ligament injury. The lateral ankle ligament structures that normally stabilize the outer side of the ankle were no longer functionally present. In other words, this was not simply a stretched or partially torn ligament, but a chronic instability case with effectively no viable ligament left to repair.

Given the extent of the damage, Dr. Diego performed a lateral ankle reconstruction, using arthroscopy in a limited, supportive role to assess the joint internally, while carrying out the main reconstruction through a precise surgical approach. This hybrid technique allows both accurate diagnosis inside the joint and a stronger, more controlled reconstruction when native ligament tissue is no longer sufficient.

The procedure was completed successfully, restoring structural stability to the ankle. Her recovery plan now focuses on early controlled movement, with gradual weight-bearing expected to begin at around four weeks, depending on healing progress. Physiotherapy will be essential in the next phase of recovery, helping her rebuild strength, coordination, and confidence in the joint.

Understanding Lateral Ankle Reconstruction in Chronic Cases

Chronic ankle instability develops when the ligaments on the outer side of the ankle, most commonly the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL); are repeatedly injured and fail to heal properly. In early or moderate cases, these ligaments may still be repaired. However, in long-standing or severe cases like this one, the ligament tissue can become too damaged or absent, making direct repair impossible.

In such situations, reconstruction is required rather than repair. This involves recreating the function of the ligament using either remaining tissue, tendon grafts, or reinforced fixation techniques anchored into the bone. The goal is to restore the natural stability of the ankle so it can function reliably again under normal daily and physical demands.

Arthroscopy, while minimally used in this particular case, still plays an important role. By inserting a small camera into the joint, the surgeon can evaluate cartilage condition, remove inflamed tissue, and confirm that there are no additional injuries contributing to the instability. This ensures a more complete and accurate treatment.

Why This Approach Is Effective and Safe

For patients with severe ligament deficiency, reconstruction provides a more durable and reliable solution than attempting to repair non-viable tissue. The use of modern fixation methods, such as suture anchors or graft-based reconstruction, allows the newly created ligament structure to be securely attached and properly tensioned.

Although this approach is more involved than purely arthroscopic procedures, it is often the safest and most appropriate option in advanced cases. It restores mechanical stability to the joint, reduces the risk of further injury, and helps prevent long-term complications such as cartilage damage or early arthritis.

At the same time, the selective use of arthroscopy minimizes unnecessary tissue disruption and enhances surgical precision. This combination of techniques reflects a tailored approach choosing what is best for the patient’s condition rather than applying a one-size-fits-all method.

Recovery and Rehabilitation

Recovery after lateral ankle reconstruction is a gradual and structured process. In this case, early movement is encouraged to prevent stiffness, while protecting the reconstruction during the initial healing phase. Weight-bearing is typically introduced progressively, with many patients beginning partial to full weight-bearing at around four weeks, depending on clinical progress.

Physiotherapy is a critical part of long-term success. Rehabilitation focuses on restoring strength in the surrounding muscles, improving balance, and retraining proprioception, the body’s ability to sense joint position. These elements are essential not only for recovery but also for preventing future injuries.

With proper rehabilitation and adherence to medical guidance, patients can expect a significant improvement in ankle stability, function, and overall confidence in movement.

Broader Surgical Expertise

Dr. Diego’s expertise in managing complex ankle instability is part of a broader orthopedic practice dedicated to restoring mobility and function. His surgical experience includes procedures such as anterior cruciate ligament (ACL) reconstruction, meniscal surgery, and quadriceps tendon repair, as well as fracture fixation techniques like proximal humerus fracture repair using plates and screws and removal of hardware such as proximal tibial plates.

In addition to complex joint procedures, Dr. Diego also manages shoulder conditions including instability and rotator cuff repair and treats knee injuries ranging from straightforward ACL reconstruction to complex knee instability and advanced muscle repair. In the ankle, his work spans both acute injuries and chronic instability cases requiring tailored reconstruction techniques, reflecting a comprehensive and versatile approach to patient care.

A Tailored Approach to Every Patient

This case highlights an important principle in orthopedic care: not all ankle injuries are the same, and treatment must be adapted to the severity of the condition. In patients where the ligament is no longer present, reconstruction offers a reliable path back to stability and function.

Through careful assessment, appropriate surgical technique, and structured rehabilitation, even complex cases of chronic ankle instability can be successfully treated, helping patients return to a more active, confident life.

Dr. Diego Mendizábal is an experienced orthopedic surgeon specializing in the diagnosis and treatment of musculoskeletal conditions. He has extensive expertise in managing sports injuries, joint disorders, and degenerative conditions, with a particular focus on arthroscopic procedures and joint reconstruction. Dr. Mendizábal is committed to helping patients restore mobility and improve quality of life through evidence-based care and personalized treatment plans.

FMP Healthcare Group operates medical centres in major cities including HCM City, Hà Nội and Đà Nẵng, offering consultations with international doctors, check-up centres and emergency ambulance services.

Visit FMP Thao Dien in Ho Chi Minh City to consult with Dr. Diego Mendizábal.

To book an appointment, please call (028) 3744 2000 (FMP - Thao Dien), or email ortho.assist@vietnammedicalpractice.com