The ankle and foot are held together by ligaments and tendons. The ligaments on both sides of the ankle are tightly attached to the bones. On the outside (lateral) aspect of the ankle, there are three major ligaments called the lateral collateral ligaments (LCL). On the inside (medial) aspect of the ankle, there is a complex network of ligaments called the medial collateral ligaments (MCL).
Ligaments help to restrict the motion of the ankle joint. When there is an injury to the ligaments, they can be stretched out or torn. This can lead to a sprain of the ligament, weakening them. In cases that are left untreated, or in cases where many sprains are experienced in a short period of time, there will be weakening of the ligaments leading to instability of the ankle.
Your doctor may determine that your ligament tears or ankle instability are severe enough to require surgery. The type of surgery depends on the injury to the ligaments. In some cases, ligaments can be tightened and strengthened again by placing them back onto the bone in their anatomic position, possibly using a small anchor to attach the ligaments into the bone.
When the ligaments are too weakened or destroyed to repair, your doctor may recommend ligament reconstruction. Ligament reconstruction surgery involves harvesting a tendon to replace your damaged ligament. The most common source is your peroneus brevis tendon (the tendon that pulls the outside of the foot upwards.) The tendon will be routed through the bones of the ankle to reinforce the ankle and provide the support that the ligament had previously provided.
Of the many different types of ankle ligament procedures or modifications of procedures performed, the more common ones are direct lateral ligament repair, peroneus brevis tendon rerouting, peroneus brevis tendon loop, and peroneus brevis tendon split and rerouting.