Tightrope ankle surgery stabilizes certain ankle joint injuries. This advanced technique uses a specialized device to secure the tibia and fibula bones. The surgery aims to restore ankle stability, promoting healing and function. It offers an alternative to traditional methods for specific ankle conditions.
Conditions Treated
Tightrope ankle surgery is recommended for injuries affecting the tibiofibular syndesmosis, known as high ankle sprains. This injury involves the strong ligaments connecting the tibia (shin bone) and fibula (smaller lower leg bone) just above the ankle joint. When these ligaments are stretched or torn, the ankle joint can become unstable, a condition called diastasis.
The procedure also applies to certain ankle fractures where the syndesmosis is disrupted, causing instability between the tibia and fibula. These injuries often result from forceful twisting or rotational movements of the foot, causing pain, swelling, and weakness. Surgery becomes necessary when instability is severe or conservative treatments like rest and bracing are ineffective.
Surgical Technique
The tightrope surgical technique involves implanting a specialized device, often called a suture-button construct, to stabilize the ankle. After a small incision, the surgeon drills a tunnel through the fibula and then the tibia. A braided polyethylene cord, the “tightrope,” passes through this tunnel. This cord is secured on each side of the bones by small metal buttons.
One button rests against the outer side of the fibula, while the other is pulled flat against the inner side of the tibia. The surgeon then tightens the cord, drawing the tibia and fibula into their correct alignment. This system provides dynamic stabilization, allowing for physiological movement between the bones, unlike traditional rigid screw fixation. This flexibility supports the natural biomechanics of the ankle and can potentially reduce the need for a second surgery to remove hardware.
Post-Operative Care
Post-operative care involves immobilizing the ankle in a splint or boot and managing pain with medication. Patients should keep the ankle elevated and apply cold compression to control swelling. Early ankle mobilization is encouraged, with gentle range-of-motion exercises starting within the first post-operative week.
Weight-bearing progression starts earlier than with traditional methods, often within days or weeks, due to the tightrope system’s stability. Patients transition from non-weight-bearing to partial, then full weight-bearing in a walking boot. Physical therapy is a part of recovery, focusing on restoring range of motion, strengthening ankle muscles, and improving balance and proprioception. Full weight-bearing out of the boot occurs around 3 to 6 weeks, with a return to strenuous activities and sports ranging from 2 to 4 months, depending on individual progress.