Foot/Ankle Ligament and Tendon ReconstructionBy
Sarah Lewis, PharmD
What is ligament and tendon reconstruction?
Foot and ankle ligament and tendon reconstruction is surgery that repairs damaged ligaments or tendons in the lower extremity. Tendons are long thin bands that attach your muscles to bones. Ligaments connect bones to each other to support a joint. Tendons can tear partially or completely during a joint injury. Ligaments can tear or stretch and become loose after repeated strains. Tendon and ligament reconstruction can restore joint stability and range of motion.
Normal joint movement requires healthy nerves, muscles, ligaments and tendons. Nerves send signals to muscles to tell them to contract. A joint moves when muscles contract and pull on tendons, moving the bones. Ligaments span the joint and limit how far a joint can move. This protects against dislocation and hyperextension.
Ligaments and tendons are both made of connective tissue, but their structure is different. Ligaments are not designed to stretch. This helps them perform their passive function of limiting joint motion. Tendons, on the other hand, are designed to be elastic and stretch to allow active movement.
Injuries and other problems with ligaments or tendons can cause joint problems. It is difficult for severely damaged ligaments and tendons to heal on their own.
Ligament and tendon reconstruction is major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having ligament and tendon reconstruction.
Types of ligament and tendon reconstruction
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The types of ligament and tendon reconstruction include:
Direct primary repair, which involves suture or stitches to perform the repair
Secondary repair, which involves a graft or tendon transfer to supplement and support the repair
Other procedures that may be performed
Your doctor may perform other procedures in addition to ligament and tendon reconstruction. These include:
Bone spur removal, which removes an overgrowth of bone that rubs against a tendon
Osteotomy, which is the cutting and shifting of bones to correct deformity or bone misalignment
Why is ligament and tendon reconstruction performed?
Your doctor may recommend foot and ankle ligament and tendon reconstruction if you have ligament and tendon damage causing severe pain, joint misalignment, joint instability, deformity, or disability. Your doctor may only consider ligament and tendon reconstruction if other treatment options have not relieved your symptoms. Ask your doctor about all of your treatment options and consider getting a second opinion.
Your doctor may recommend foot and ankle ligament and tendon reconstruction to treat damage to ligaments and tendons due to:
Acute injuries, causing strains and partial or complete tears
Bone spurs, which can rub against a tendon
Degenerative changes, which weaken the ligament or tendon with age
Overuse injuries, which places repetitive stress on the ligament or tendon
Who performs ligament and tendon reconstruction?
Orthopedic surgeons and foot and ankle surgeons perform ligament and tendon reconstruction. Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments. Foot and ankle surgeons are orthopedic surgeons or podiatrists who further specialize in surgery of the foot, ankle, and lower leg.
How is ligament and tendon reconstruction performed?
Your foot and ankle ligament and tendon reconstruction will be performed in a hospital or outpatient surgery setting. Ligament and tendon reconstruction is an open surgery involving at least one incision. Procedures vary depending on your diagnosis and the ligaments and tendons that need repair. The number of incisions and the use of hardware to secure the repair will vary depending on your condition.
Types of anesthesia
Your surgeon will perform your ligament and tendon reconstruction using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your ligament and tendon reconstruction
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and during your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of ligament and tendon reconstruction?
As with all surgeries, ligament and tendon reconstruction involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and breathing problems
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of ligament and tendon reconstruction
Complications of foot and ankle ligament and tendon reconstruction are not common but include:
Blood vessel injury
Development of arthritis
Failure to heal
Recurrence of deformity
Severe joint swelling
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This may include physical therapy and foot and ankle exercises.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my ligament and tendon reconstruction?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for foot and ankle ligament and tendon reconstruction by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include X-rays, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your surgeon with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need ligament and tendon reconstruction? Are there any other options for treating my condition?
What type of procedure do I need?
If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
Will I need physical therapy and occupational therapy? Where do I go for it?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my ligament and tendon reconstruction?
Knowing what to expect can help make your road to recovery after ligament and tendon reconstruction as smooth as possible.
How long will it take to recover?
You will stay briefly in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will likely go home the same day as your ligament and tendon reconstruction.
You will wear a cast for a couple of weeks, followed by a boot for up to eight weeks. Physical therapy will help you regain ankle strength and movement. You will gradually return to normal activities and add new ones. Your surgeon and therapist will tell you when it is safe perform specific activities.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, your age, and other factors. Full recovery takes up to 12 months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up and physical therapy appointments after ligament and tendon reconstruction. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Numbness, tingling, or excessive swelling in the affected leg or foot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might ligament and tendon reconstruction affect my everyday life?
Ligament and tendon reconstruction can improve foot and ankle function so you can lead a more active, normal life. It can help you to be more independent and return to many activities. The results of your ligament and tendon reconstruction will depend on the severity of the damage and the amount of motion possible before surgery. Ask your doctor what you can expect from your ligament and tendon reconstruction.
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