How fixing a tightrope to your legs will stop your ankles giving way

Two million people a year sprain their ankle so badly they need medical treatment, and sometimes surgery.

Property developer Sir Stuart Lipton, 66, the Government's former architecture tsar, had a new procedure that halves the recovery time.

Here, he talks about his operation... 


My ankle have never caused me any problems until two years ago, when, while getting out of the shower, I slipped on the bath mat and my right knee folded inwards and under me.

It was extremely painful, but I thought I'd just yanked the ligaments in my ankle. I put ice on it and rested my leg for the rest of the day, but by the evening my ankle had swollen to the size of a small melon.

The following morning it was still swollen, so my wife drove me to A&E. A doctor told me that as well as damaging the ligaments, I'd fractured one of my lower leg bones.

Unsteady on your feet? A serious ankle sprain or fracture makes you prone to arthritis

Unsteady on your feet? A serious ankle sprain or fracture makes you prone to arthritis

They then put my lower leg in plaster as a temporary measure and told me to return to see the orthopaedic surgeon, who wasn't around that afternoon, the following day.

But once I got home, I contacted my GP as I was keen to speed things up. He referred me to orthopaedic surgeon Mark Davies. He saw me that night, and said I'd torn the thick ligament that holds the ends of the two lower leg bones together at the ankle.

This ligament would usually heal, but only if the two bones (the fibula and the tibia) were nestling together as normal.

Without a repair to hold them together, I'd have what's known as an unstable ankle, which causes a lot of pain, would predispose me to other sprains, and can rapidly lead to arthritis.

Surgery was the only option. This usually involves a screw being drilled through the lower leg bones to hold them together. But the leg then has to be in plaster for two months, and you have to wear a special 'walking boot' for another two.

Another operation to remove the screw is also necessary before starting physiotherapy; it's a pretty long haul.

Mr Davies proposed a new procedure, TightRope fixation, which would do the same job as the screw but didn't require a second operation before physiotherapy. I jumped at the chance.

I was admitted to hospital the following morning. The operation took around 30 minutes and I woke up from the general anaesthetic in absolutely no pain, but was kept in overnight just to be on the safe side.

I was on crutches and in a full fibreglass plaster for six weeks, but then started physiotherapy every fortnight. I also had a blow-up boot to protect my ankle, but I really only used that if I went on a long walk.

After three months I was completely back to normal and back in the gym. The recovery time would probably have been at least twice as long with the screw. The

whole experience was painless and efficient, and I'm delighted with the result.


Mr Mark Davies is a consultant orthopaedic surgeon at the London Foot & Ankle Centre at St John & St Elizabeth Hospital, London. He says:

Ankle sprains are extremely common. While the less severe sprains respond well to ice packs, bandaging and keeping the leg elevated for a few days until the worst of the inflammation subsides, Sir Stuart had what is called a highankle sprain, which is far more serious.

When he fell, Sir Stuart ruptured the strong band of ligament that binds the two lower leg bones together at the ankle. He also complained of pain around his knee. He had the sort of symptoms that often accompany this sort of injury.

'Unfortunately, high-ankle sprains are often missed in A&E as doctors can easily underestimate the severity of the injury. Patients are told simply to go home and rest while the swelling subsides. Yet without proper repair, this sort of ankle sprain won't get better and can lead to an unstable ankle.

This can be very painful and, if missed, or not surgically repaired, can rapidly lead to deformity with the foot drifting inwards or outwards, and painful arthritis.

'This ruptured ligament is very short but wide. It can't be repaired by stitching as the ends will be frayed from the rupture.

Surgery puts the lower leg bones back in position so that the ligament ends nestle close to each other, perhaps a millimetre or so apart. New tissue then grows to join the ligament ends together, leaving it as strong as it was prior to the injury.

For years, standard treatment involved putting a screw in to pull the tibia and the fibula together at the ankle. The problem with this is that nature intended there to be a bit of movement between these bones, which the natural ligament that holds them together provides.

It means the screw is prone to loosening or breaking, simply because there is no play in the tension of the screw. Also, the screw must be surgically removed before the patient starts physiotherapy or it will interfere with proper joint movement.

The TightRope procedure does the same job as the screw. The major advantage it has is that although it's secure, like natural ligament, it has a bit of flexibility to it.

First we made a 1cm incision about 4cm above the end of the fibula. We then clamped the lower leg bones together, checking on an X-ray that they were aligned correctly.

Next we drilled a 3.5mm hole through the fibula and tibia (but didn't drill through the skin on the other side of the ankle). Then, having made this tunnel through the bones, we passed through the TightRope  -  an incredibly strong synthetic rope material on a special needle.

This has a rectangular button attached to it which lodges against the bone  -  rather like an anchor would.

We pulled this to the correct tension before doing the same thing with another button on the other side of the ankle, which again lodges against the bone.

This is the TightRope; we then tied a knot in it and closed up the skin with a stitch. Patients leave with the lower leg bandaged.

This can be done as day surgery but some patients, such as Sir Stuart, will have an overnight stay. For the first two weeks, patients are on crutches and wear a plaster back slab which supplies support. They must avoid putting any weight on the ankle.

Two weeks after surgery, patients go into a full fibreglass plaster for a month. When they come out of this they start wearing an air boot for support, and at that stage can start physiotherapy. The wire simply stays there, with no ill effects, enabling patients to get going with physiotherapy far earlier.

Most patients will be back to normal at three months  -  half the time it takes with the screw technique. Sir Stuart is a prime example of this, and I'm delighted he's so pleased with the result.

• TightRope fixation costs the NHS £3,000. Privately, it will cost about £4,000.

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