ATFL Surgery and recover

Well... fuck. It is obviously difficult to hear these stories of failure and how they are at odds with what my docs are telling me. Anyone out there have any success with the non-surgical path?

Michael Tranum wrote:

...In Aug ‘22 I saw a different doc and had a new MRI- basically everything became so loose the ankle could move around and partially dislocate. New doc told me no amount of strength training would fix that and their practice was to always repaired surgically for any active adult....

Michael - was their approach to go non-surgical for the first injury and then repair if necessary? Or were they firmly in favor of repairing on first injury?

In conversations with the 2nd surgeon I saw, the impression I was left with was that in cases where multiple ligaments are mostly or fully torn their practice defaulted to surgery. I had an Avulsion fracture where the ATFL tore away and the ligament was obliterated, the Deltoid was completely torn and the CFL was partially torn. His comment to me was something to the effect of their practice always recommends surgery when the injury is the result of fall/trauma and damage is that bad. Basically even when the ligaments heal they’re very stretched out and don’t do their job. He appeared very surprised surgery wasn’t recommended to me from the onset.

Keep in mind I’m not a doctor so I’m basically just parroting here, but I can tell you for certainty in my case it is a day and night difference between the natural heal and surgical fix. The interesting control factor is I did PT at the same place both post break and post surgery, PT protocols were the same. 

Sorry to keep beating a dead thread here but I actually posted this same question two months ago and never got an answer so I wanted to try again here. I’m planning to get surgery in a month or so now, I can walk and climb fine but my ankle is so unstable that I have anxiety walking around my house and keep it in a brace daily. I have postponed surgery the last year because I didn’t want to take this much time off but now I’m missing more time from the constant injuries. I wanted to see if anyone has had the lateral ligament reconstruction before with the arthrex internal brace?  I found a few reviews of people being back in 2-3 months which sounds unbelievable literally. If anyone has had this specific surgery due to chronic ankle instability I’d love to talk to you for a minute either on here or shoot me a message. Thanks very much as always!

I tore my ATFL fully, bruised my talus dome, partially tore my perennials, upper and lower sprains on supporting ankle and leg muscles. This was a from a 30ft drop to flat snowboarding.

I am 6 months out from recovery. Saw many sports docs and a PT they all said no surgery because my ankle was very “tight” with limited mobility and would scar in that way as it healed.

The PT said they see similar injuries with ankles that are loose and floppy for one reason or another. Those do not have good luck healing without surgery. They urged me to avoid any activities where I would re-injure the joint. Because it would stretch the tissue fibers and continue to loosen. Fortunately I have been able to pull this off.

I used to skateboard. I still cant flick my ankle without pain while doing tricks. Swimming also hurts deep in the joint while flicking my feet to kick.

I can run, and climb with no pain. I am hoping it continues to improve. Unfortunately the pain has stayed the same for the past two months. By next winter I am hoping to have full functionality so I can hit jumps and drops again on my board without fear. My articulation, flexion, and mobility is still limited but the PT says thats the way I want it. Tighter is better and I need to work into the new range of motion. 

I've had ankle issues for a few years.  Initially it would just be swollen and sore after trips to Indian Creek, but the swelling would go down after a couple weeks and it never limited me otherwise.  I'd trip over it a ton after it got tired on long hikes for as long as I can remember, but this rarely ended in any soreness lasting more than a day or so, and I always joked that it was because my ankle was so loose that there was nothing left to sprain.  Then a couple of years ago the tissue around the lateral malleolus became mildly swollen all the time, never being normal size, but it wasn't painful or limiting at all.  Last spring during a trip to the creek, it did become very painful and felt like it was going to buckle if I tried to weight it in a crack after the first day, so I couldn't really climb much the rest of the trip.  Again, the increased swelling and soreness went away in a few weeks, back down to its new baseline of mild swelling.  Again, at a creek trip this spring it swelled up as though I had a 3rd degree sprain by the end, but I was taping it every day and it never got that buckling sensation.  I finally bit the bullet a few weeks ago and saw an ortho (but one who specializes in regenerative medicine vs. surgeon since I was assuming it was a chronic injury and that was the way I was hoping to go!).   Anyway, got an MRI, and among other things (peroneal tenosynovitis, marrow edema in the posterior talus, edema in the posterior talocrural joint, and very mild arthritis), it found no evidence of an ATFL (aka I've had a complete rupture), and likely those other findings are due to the long term instability as a result.  My guess is that I ruptured it as a kid since I haven't had any major ankle blowouts since then and I had a couple good ones back then.  Even so, other than crack climbing, I don't feel particularly limited.  It's mildly sore and I've got some posterior impingement pain with plantar flexion.  My long story is partly to give one individuals experience with climbing with a ruptured ATFL.  For 20+ years it didn't limit me at all.  But, now I essentially can't crack climb anymore, and I'm worried about the state of my ankle in 10 years now that it's obviously causing some damage.  I haven't talked to a surgeon yet, mostly trolling online to see if I really need to get surgery since so many PT's say it's not necessary for a ruptured ATFL.  But after reading this thread I'm getting an impression that it may be the way to go...

Figured I'd loop back. Surgery was the best decision I could have made. The swelling that had been present for four months went away within a month after the surgery and I regained function surprisingly quickly (I was sport climbing at my limit within twelve weeks from the surgery date). My ankle is now totally stable - I can crack climb, alpine climb, run, do 20+ mile day hikes, and backpack/approach with weight on talus and scree for as long as my leg muscles will hold out. As far as I can tell, I have no residual pain or major limitations other than needing to crack it occasionally here and there during a long day. The only other lingering side effect is slightly limited forward flexion in the affected ankle and I only notice it if I'm testing it out in comparison to the other ankle's range of motion. And, I believe because I waited so long to get the surgery and dealt with such a prolonged time of swelling, my foot is now almost a half size bigger than it used to be, which is lame for sizing shoes. Anyways, good luck everyone dealing with this injury. 

AMT wrote:

Figured I'd loop back. Surgery was the best decision I could have made. The swelling that had been present for four months went away within a month after the surgery and I regained function surprisingly quickly (I was sport climbing at my limit within twelve weeks from the surgery date). My ankle is now totally stable - I can crack climb, alpine climb, run, do 20+ mile day hikes, and backpack/approach with weight on talus and scree for as long as my leg muscles will hold out. As far as I can tell, I have no residual pain or major limitations other than needing to crack it occasionally here and there during a long day. The only other lingering side effect is slightly limited forward flexion in the affected ankle and I only notice it if I'm testing it out in comparison to the other ankle's range of motion. And, I believe because I waited so long to get the surgery and dealt with such a prolonged time of swelling, my foot is now almost a half size bigger than it used to be, which is lame for sizing shoes. Anyways, good luck everyone dealing with this injury. 

So glad to hear of your success AMT! 

It's really interesting hearing the different mileage people have had with ATFL injuries. Just giving an update myself, I had the opposite experience! Completely tore it 5 months ago, I never had any instability and I don't even think about it while trail running/foot jamming any more. No surgery worked well!

I had a ruptured ATFL injury with fib and calcaneous fractures, and various other 2nd/3rd degree tears in other ligaments in the left ankle after slamming into the wall on a bad lead fall. Doctor 1 said absolutely needed surgery. Doctor 2nd opinion did a stress X-ray and confirmed the ankle was relatively “stable” meaning bones were not separating on manual manipulation of the joint. I’d recommend having this test. I was non weight bearing on crutches 2 months and air boot for 2-3 more. So 5 month recovery after which I was able to slowly progress to running again, with some pain that improved after a few months. I actually quit climbing after this accident for almost 2 years. I was running pain free 9 months after the injury.
When I finally returned to climbing (1.5-2 years after the injury, so maybe not the best reference point) - heel toe cams still hurt a lot. Prior to the injury I climbed a lot of steep terrain with aggressive heel toe cams which I could not do for a long time. I can now do so without pain, so I assume it was a matter of stretching scar tissue. 

It’s been 4* years since my injury and I would say my ankle without having had surgery is pretty much back to normal minus some very mild aches at times with overuse.

Hope this helps some and good luck. I’d suggest having the stress X-ray test to get a better idea of whether or not the bones are moving apart when you rotate.