Ace Physiotherapy and Sports in Singapore
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+65 81535374 -
ACE PHYSIO SPORTS
East gate Building, 46 East Coast Road
#08-03 Singapore 428766 -
Opening Hours
Mon to Fri: 08:00am - 8:00pm -
Opening Hours
Sat: 08:00am - 4:00pm
Sunday (By prior appointment)
Ligament Reconstruction - ATFL Repair
A ligament is a type of soft tissue that connects bone to bone. Ligaments provide stability to a joint and help limit or prevent excessive movements, reducing the risk of injury. The ankle joint is supported by four main ligaments:
- Anterior Talofibular Ligament (ATFL): Provides stability to the outer (lateral) ankle and is most commonly injured during ankle sprains.
- Calcaneofibular Ligament (CFL): Supports the lateral ankle and prevents excessive inversion of the foot.
- Posterior Talofibular Ligament (PTFL): Strengthens the back of the ankle joint, providing stability during extreme movements.
- Deltoid Ligament: A strong, triangular ligament on the inner (medial) ankle that prevents excessive eversion.
The first three ligaments—the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL)—are located on the outside (lateral) aspect of the foot and ankle. In contrast, the deltoid ligament is situated on the inside (medial) ankle. The deltoid ligament is much stronger than the lateral ligaments and, as a result, is less commonly injured.
When a ligament is damaged, it is referred to as a sprain. Sprains can occur due to twisting the ankle, a fall, sudden trauma (such as a kick), or if the ankle is already unstable from a previous injury. The anterior talofibular ligament (ATFL) is the most frequently injured ligament, as it is weaker than the other ankle ligaments. The ATFL is typically damaged when the foot and ankle are in a plantarflexed (pointed forward) and inverted (slightly inward) position. This movement stretches the ATFL, making it more vulnerable to injury. Symptoms of an ankle sprain include:
- Pain around the affected ligament
- Swelling and bruising of the ankle
- Tenderness to touch
- Difficulty bearing weight on the affected foot
- Reduced range of motion or stiffness
- A feeling of instability in the ankle
Ankle sprains are classified into different grades depending on the severity of ligament damage. Most sprains can be managed non-surgically, and only severe injuries may require surgical intervention.
Grade I (Mild):
- Minor stretching of the ligament
- Mild pain and swelling
- Usually no joint instability
- Recovery typically occurs within a few days to weeks
Grade II (Moderate):
- Partial tear of the ligament
- Moderate pain, swelling, and bruising
- Some joint instability may be present
- Recovery may take several weeks with physiotherapy
Grade III (Severe):
- Complete rupture of the ligament
- Significant pain, swelling, and bruising
- Marked joint instability
- May require surgical repair followed by physiotherapy
Grade I and II ankle ligament sprains are usually managed conservatively. Initial treatment involves the R.I.C.E. method—rest, ice, compression, and elevation—to reduce pain and swelling. Once the acute symptoms have settled, physiotherapy interventions can begin, including electrotherapy techniques such as ultrasound, gentle joint mobilisation, and soft tissue massage to restore movement, reduce stiffness, and improve circulation. For more detailed guidance, please refer to our pages on conservative management of minor ligament tears.
If you have sustained a Grade III ligament tear, you may initially be advised to undergo six weeks of conservative treatment before considering surgery. However, if this approach does not relieve pain and joint instability, surgical reconstruction of the ligament will be recommended. Typically, the procedure involves tightening the damaged ATFL ligament and reattaching it to the bone, restoring its original strength and function. In cases where the ligament is too severely damaged to repair, a tendon graft may be performed instead. This involves using a section of a nearby tendon—often from the peroneus brevis muscle—to replace the ligament, which is then allowed to heal and regain stability.
Physiotherapy prior to ligament reconstruction
If you require an ankle ligament reconstruction, you may be placed on a waiting list or given several weeks to determine if surgery is the best option. During this period, it is essential to maintain the range of movement and strength in your uninjured ankle and to support healing of the injured ligament as much as possible. At Ace Physio Sports, our experienced physiotherapists will design a personalised rehabilitation programme to optimise your recovery and minimise the risk of further complications. During this stage, rehabilitation will focus on:
- Maintaining mobility in the injured ankle without overstressing the ligament
- Strengthening surrounding muscles to support joint stability
- Reducing pain and swelling through gentle exercises and modalities
- Balance and proprioception training to maintain coordination and prevent further injury
- Education on safe movement and activity modifications
Symptoms following ligament reconstruction surgery
Following ankle ligament reconstruction surgery, you will be fitted with an aircast boot to wear for approximately three weeks. This allows for controlled movement of the foot and ankle while providing support. You will generally be able to gently weight-bear immediately after the operation, depending on your comfort and the surgeon’s guidance. After surgery, it is normal to experience a range of symptoms, which may include:
- Mild to moderate pain around the surgical site
- Swelling and bruising of the ankle
- Stiffness or tightness in the joint
- Tenderness when touching the incision area
- Temporary numbness or tingling due to local anaesthetic or nerve irritation
Physiotherapy following ligament reconstruction
Weeks 1-3
Initially, you will be placed in an aircast boot but will still be able to weight bear as tolerated. During this early stage, your physiotherapists at Ace Physio Sports may focus on the following treatments:
- Gentle range of motion exercises for the ankle and foot
- Isometric strengthening exercises for the calf and lower leg
- Edema and swelling management using elevation, compression, or manual techniques
- Soft tissue massage to reduce stiffness and improve circulation
- Balance and proprioception exercises within safe limits to maintain coordination
Weeks 3-6
After three weeks, your aircast boot will be removed, and you will be able to freely weight bear on your affected ankle. At this stage, your physiotherapy programme at Ace Physio Sports will focus on progressive rehabilitation to restore strength, mobility, and function. This may include:
- Advanced strengthening exercises for the ankle, foot, and lower leg
- Dynamic balance and proprioception training to improve stability
- Stretching and mobilization to restore full range of motion
- Gait retraining to ensure a normal walking pattern
- Functional and sport-specific exercises tailored to your goals
Weeks 6-12
By this stage, your ligament reconstruction should be healing well, and you should begin to feel the benefits of a stabilised ankle joint. The physiotherapists at Ace Physio Sports will continue to progress your rehabilitation programme, with a focus on functional activities tailored to your sport, hobbies, or work requirements. If you have a manual or physically demanding job, it may take longer to return to your normal daily activities compared to a more sedentary role. Similarly, if you participate in contact or high-impact sports, your physiotherapist will ensure your graft is sufficiently strong before returning to full activity, reducing the risk of re-injury. Ace Physio Sports will assess your readiness and guide you safely back to your chosen activities.
Summary
An ankle ligament reconstruction involves a tightening procedure of a damaged ankle ligament, most commonly the anterior talofibular ligament (ATFL). The surgery is highly successful, and with an appropriate rehabilitation programme, you can return to your normal level of independence safely and efficiently. With a specialised programme devised by the physiotherapists at Ace Physio Sports, you will be able to reach your full potential as soon as possible. To book an appointment with one of our experienced physiotherapists, please call +65 81535374
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