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Ankle lateral ligament reconstruction

Dear Sir,

As part of lateral ligament reconstruction, my foot/ankle surgeon has discussed removing the fibular avulsion fragment.  On MRI, it's measured at 1.43 x 0.6cm and the ATFL is clearly attached to the fragment.

Is it common to find yourself without enough natural tissue/ATFL to work with and to then have to use some kind of graft (like tendon) to augment the repair?

This scares me.

Thank you so much for your contribution!

(IMAGES MIGHT BE POTENTIALLY DISTURBING, CLICK TO REMOVE BLUR)

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Dr. Ken J T
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Hello, it’s not that uncommon to have a bony avulsion fragment from the fibula, like in your ankle. It’s still controversial what’s the best thing to do with the fragment, and this can vary from removal to leaving it alone and just focusing on repairing the ligament. When there’s not enough good quality tissue to work with, yes an augmentation is useful. This can be in the form of a tendon, or a synthetic internal brace device has also become quite popular. How “common” it is to have inadequate tissues can be quite subjective depending on the judgement of the surgeon but usually it is better to augment the repair when in doubt. 
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@lunarorbit
Thanks a lot for this!

I didn't realize you could use the internal brace to bridge in this way.  

I don't really have any problem with spraining my ankle.  It's not happening.  I just have an achy pain and soreness after exercise/walking, along with a positive anterior drawer.  It feels to me like the soreness is associated with a "loose" feeling in the joint.  Hard to describe.

The pain has had a major impact on my lifestyle.  A lace up splint helps a lot.  
Docs think the fragment may be contributing to the pain. 

So, I'm just trying to decide if it's worth the risk of anatomical changes to get the reconstruction...
@Ad
Oh okay...
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@Ad
Oh Okay
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