Ankle sprains are the most common injuries sustained during sports activities. Most ankle sprains recover fully with non-operative treatment but 20-30% develop chronic ankle instability. Predicting which patients who sustain an ankle sprain will develop instability is difficult. This paper summarises a consensus on identifying which patients may require surgery, the optimal surgical intervention along with treatment of concomitant pathology given the evidence available today. It also discusses the role of arthroscopic treatment and the anatomical basis for individual procedures.

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SUMMARYFormulation of the scale transition equations coupling the microscopic and macroscopic variables in the second-order computational homogenization of heterogeneous materials and the enforcement of generalized boundary conditions for the representative volume element (RVE) are considered. The proposed formulation builds on current approaches by allowing any type of RVE boundary conditions (e.g. displacement, traction, periodic) and arbitrary shapes of RVE to be applied in a unified manner. The formulation offers a useful geometric interpretation for the assumptions associated with the microstructural displacement fluctuation field within the RVE, which is here extended to second-order computational homogenization. A unified approach to the enforcement of the boundary conditions has been undertaken using multiple constraint projection matrices. The results of an illustrative shear layer model problem indicate that the displacement and traction RVE boundary conditions provide the upper and lower bounds of the response determined via second-order computational homogenization, and the solution associated with the periodic RVE boundary conditions lies between them.

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