Monday, 30 May 2016

Georgetown Accelerated Ankle Ligament Reconstruction Post-op Protocol - 2016

Dr. Christopher Lu MBchB FRCSC / Darryl Yardley M.Sc.PT
Ankle ligament reconstruction post-op protocol


PRE-OPERATIVE PHYSIOTHERAPY:


- Gait training, advice on edema control and pain management: rest, elevation, breg kodiak
- Ankle strengthening; Proprioception
- Assess with AOFAS Ankle/Hindfoot Scale
- Purchase - crutches, knee walker and cast protector
- If you are interested in pre-operative physiotherapy and a pain management consult please call Restore Physiotherapy Georgetown - 905-702-1840


0 - 2 WEEKS:


- Non-weight wearing in short leg back slab and breg cooling unit.
- Leg elevation and cold therapy for edema control
- Mobilize with crutches, knee walker or iWalk 2.0
- Keep cast clean and dry - use cast protector in shower
- Sutures removal and wound check at 2 weeks post-op
- Toe curls, toe spreads / extension
- Take aspirin 81 mg - once a day for DVT prophylaxis - if there are no contraindications / allergies
- Continue aspirin every day you are in a cast.


2 - 6 WEEKS:

- Short leg back slab, breg cooling unit and sutures removed
- Change to new short leg cast, continue non-weight bearing
- Continue to mobilize with crutches, knee walker or iWalk 2.0
- Keep cast clean and dry - use cast protector in shower
- Toe curls, toe spreads / extension
- Take aspirin 81 mg - once a day for DVT prophylaxis - if there are no contraindications / allergies
- Continue aspirin every day you are in a cast.


6 - 12 WEEKS:


- Short leg cast removed
- Cover wound with Band-aid advanced healing bandage - this can be left on for several days at a time and is waterproof.
- Start physiotherapy at 6 weeks post-op
- ROM (Range of motion) in unilateral planes focus on dorsiflexion and progress to active exercises in protected ranges, avoid inversion, ankle traction, and tibio-fibular mobilization.
- Proprioception exercises, intrinsic muscle strengthening, start isometric eversion.
- Soft tissue treatments (plantar fascia, gastroc/soleus, achilles) and regular mobilization of intermetatarsal and midtarsal joints.
- Passive and active range of motion exercises (restore full ROM / multi-planar motions)
- Open kinetic and closed kinetic chain strengthening.
- Gradually progress closed-chain and balance / proprioception.
- Cycling, aerobic machines as tolerated.
- Can transition to anke brace at 6 weeks post-op
- AVOID: ankle traction, forced plantarflexion and ankle inversion for 12 weeks


3 - 6 MONTHS:


- Progress back into athletics based upon functional status at discretion of Orthopaedic Surgeon.

- Assess with AOFAS Ankle/Hindfoot Scale  (Post-op - 3 months and 6 months)

Disclaimer:  This physiotherapy protocol is specifically designed for patients who have had their ankle instability surgery performed at Georgetown Hospital.


Tuesday, 9 February 2016

Recommended aids to help with post-op recovery

1) Breg Kodiak Cold Therapy + Ankle / Foot Attachment / Game Ready / Ossur



US Amazon Link:


2) Walking Aids - Crutches / Knee Scooter / iWalk 2.0


US Amazon Link:

Crutches
Knee Scooter
iWalk 2.0

Canada Amazon Link:

Crutches
Knee Scooter
iWalk 2.0

3) Shower Aids

US Amazon Link:

Cast Cover
Bath Stool

Canada Amazon Link:

Cast Cover
Bath Stool

4) Vitamin D drops - 2000 IU / day

Please start this now - in preparation for surgery.



US Amazon Link:

Vitamin D drops

Canada Amazon Link:

Vitamin D drops

5) Aspirin 81 mg / day

If you do not have a contraindication for taking aspirin.  I would recommend you take an Aspirin 81 mg / day for each day that you are in the cast.


US Amazon Link:


Canada Amazon Link:


6) Foam Bed Wedge to elevate feet



US Amazon Link:

Foam Bed Wedge

Canada Amazon Link:

Foam Bed Wedge

7) Advanced healing waterproof band-aids


 
US Amazon Link:

Advanced Healing Band-aids

Canada Amazon Link:

Advanced Healing Band-Aids


8) Diet.  Make sure you are eating a good well balanced diet with adequate amounts of protein and fruits + vegetables.  No junk food.  No fast food.  No sugar. No smoking.

9) ASO Ankle brace



US Amazon Link:

ASO Ankle Brace

Canada Amazon Link:

ASO Ankle Brace

10) Long Cast Boot


US Amazon Link:


Canada Amazon Link:


Sunday, 24 August 2014

The Brostrum Procedure

The Brostrum Procedure is the standard procedure used to correct ankle instability.

It has been performed for over 50 years.

Brostrum's original paper was written in 1966.

Below are some links about the procedure.

Recovery is generally 3 to 6 months.

Brostrum Procedure / Wikipedia

Brostrum Procedure / Wheeless

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC164377/pdf/attr_37_04_0458.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC164377/


Friday, 24 May 2013

PXB - Percutaneous X-ray Guided Internal Brace

Ankle instability treated using PXB technique - Percutaneous X-ray Guided Internal Brace.
1) Make an incision and percutaneous identify the fibula

2) Drill hole for 4.75 mm SwiveLock
3) Tap fibula
4) Insert 4.75 mm SwiveLock
5) Mark and drill talus
6) Tap talus
7) Insert 4.75 mm SwiveLock in talus and tension fiber tape appropriately
8) Post-op incisions



Pre and post-op stress X-rays:

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Monday, 20 May 2013

Tracking Outcomes - AOFAS Ankle-Hindfoot Scale

In an effort to track outcomes for our patients we will be using the AOFAS Ankle/Hindfoot Scale.  I have attached the AOFAS Ankle/Hindfoot scoring sheet.  If you are a patient it would be appreciated if you could fill out this form on your first and subsequent visits.

AOFAS Ankle-Hindfoot Scale PDF

Sunday, 28 April 2013

Clinical Prediction Rules

Darryl Yardley - one of my physiotherapy colleagues asked me if I could list some Clinical Prediction Rules / Indications for Surgery.

My main clinical indications are the following:

1) Ankle pain and instability for greater than 1 year despite non-operative management / physiotherapy.

2) Clear 2+ anterior drawer sign

3) Evident varus / valgus instability with stress testing

4) Palpable crepitus in the ankle (this can be caused by an OCD lesion or Ankle Osteoarthritis).

Tuesday, 16 April 2013

Ankle Arthroscopy + Brostrum Video

I have attached 2 video's that are quite representative of the surgery performed.  These video's are by Dr. Brian Weatherby of Steadman Hawkins Clinic of the Carolinas.



Saturday, 6 April 2013

Management of Acute and Chronic Ankle Instability

I have attached a 2008 article from JAAOS summarizing the management options for Acute and Chronic Ankle Instability.









Saturday, 30 March 2013

Ankle Instability - Dr. Christopher Lu

Ankle Instability is a common problem affecting both athletes and non-athletes a like. Most patient's have had an ankle sprain, the problem arises when you do not get better after a simple sprain. With a simple sprain you are usually able to get better after 3 to 6 months.  However, if you do not get better during this initial time frame, you might want to see your Family Physician and have your ankle examined.  Initial management consists of physiotherapy with ROM, proprioception and strengthening exercises.

If you have persistent anterior ankle pain, difficulty with uneven ground and a sensation of your ankle giving way, you might benefit from an x-ray of your ankle, followed by an MRI.  Specifically we are looking for an injury to the talar surface or ATFL (anteriortalofibular ligament - the main stabilizer of the ankle).  It should be noted that some patient's have a normal MRI, but still have instability symptoms.  These patient's also benefit from a tensioning procedure.

I have a sub-speciality interest in Ankle Instability surgery and have created a regional centre of excellence for the treatment of Ankle Instability.  If you happen to live in Canada simply have your Family Physician / Sports Medicine Physician / Orthopaedic Surgeon fax a referral to our office.  International patients are asked to contact our office for further information / pre-clearance.

Surgery is performed at Georgetown Hospital - which is located 30 minutes from Toronto Pearson Airport.  Ankle instability procedures are routinely performed as a day surgery procedure.  We routinely use a local anaesthetic block and sedation as our mode of anaesthetic.

Preferred work up for patients would be: Ankle X-ray (AP, Lateral, Mortise) + Ankle MRI.

If you have any of these injuries and are interested in reconstructive surgery please have your Family Physician / Sports Medicine Physician / Orthopaedic Surgeon refer you to:

Dr. Christopher Lu MBchB FRCSC
Assistant Clinical Professor (Adjunct) - McMaster University
Orthopaedic Foot and Ankle Surgeon
Unit 200 - 1A Princess Anne Drive
Georgetown, Ontario
Canada
L7G 4W4


Phone: 905-873-8883

Fax: 289-801-2239

Linkedin profile:

http://www.linkedin.com/in/chrisluortho

E-consult available via Champlain LHIN / Mississauga Halton LHIN E-consult service (family physician needs to be registered with E-consult service)

E-consult

RateMD reviews:
https://www.ratemds.com/doctor-ratings/3570242/Dr-Christopher-Lu-Georgetown-ON.html

Tuesday, 1 January 2013

Ankle Osteochondral Defects / OCD

Osteochondral defects are a common source of pain in the ankle.  There is limited space inside the ankle joint, when you have an OCD lesion it can often feel like you have a pebble inside your shoe, with a very disconcerting crunching noise.  Once this lesion is removed and micro-fractured the results are often dramatic.  However, there is a limitation to how much pain relief can be achieved - we cannot make you better than the uninjured side.  Once damage has been done to the chondral surface - the body heals the surface with fibrocartilage, not the rock hard hyaline cartilage that you were born with.  With microfracture alone this technique is 90% effective.

I have attached imaging of some recent osteochondral lesions that have been treated at our hospital. Georgetown Hospital is the only site in the GTA with two - Arthrex Ankle Arthroscopy Sets.

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