Ankle ligament injuries

Abstract

Acute ankle ligament sprains are common injuries. The majority of these occur during athletic participation in the 15 to 35 year age range. Despite the frequency of the injury, diagnostic and treatment protocols have varied greatly. Lateral ligament complex injuries are by far the most common of the ankle sprains. Lateral ligament injuries typically occur during plantar flexion and inversion, which is the position of maximum stress on the anterotalofibular liagment (ATFL). For this reason, the ATFL is the most commonly torn ligament during an inversion injury. In more severe inversion injuries the calcaneofibular (CFL), posterotalofibular (PTFL) and subtalar ligament can also be injured. Most acute lateral ankle ligament injuries recover quickly with nonoperative management. The treatment program, called "functional treatment," includes application of the RICE principle (rest, ice, compression, and elevation) immediately after the injury, a short period of immobilization and protection with an elastic or inelastic tape or bandage, and early motion exercises followed by early weight bearing and neuromuscular ankle training. Proprioceptive training with a tilt board is commenced as soon as possible, usually after 3 to 4 weeks. The purpose is to improve the balance and neuromuscular control of the ankle. Sequelae after ankle ligament injuries are very common. As much as 10% to 30% of patients with a lateral ligament injury may have chronic symptoms. Symptoms usually include persistent synovitis or tendinitis, ankle stiffness, swelling, and pain, muscle weakness, and frequent giving-way. A well designed physical therapy program with peroneal strengthening and proprioceptive training, along with bracing and/or taping can alleviate instability problems in most patients. For cases of chronic instability that are refractory to bracing and external support, surgical treatment can be explored. If the chronic instability is associated with subtalar instability that is refractory to conservative measures and bracing as outlined above, surgical treatment must address the subtalar joint as well. Subtalar ligament injury and instability are probably more common than appreciated. Definition and diagnosis of this entity are difficult, however. Fortunately, it appears that in the majority of the acute injuries healing occurs with the same functional rehabilitation program as that for lateral ankle ligament sprains. For chronic subtalar instability an intial attempt at functional rehabilitation with ankle proprioceptive training and bracing should be attempted. If this program fails primary repair or reconstruction can be beneficial. Reconstructive procedures must address the subtalar joint. Subtalar instability often occurs in conjunction with talocrural instability, so careful diagnosis is critical in anyone with chronic ankle instability. If either is not addressed, the patient will continue to have problems. Deltoid ligament injuries most often occur in association with ankle fractures. They are rare as isolated injuries. If no...

The Football Association Medical Research Programme: an audit of injuries in professional football: an analysis of ankle sprains

“…23 This would fit with the common mechanism of injury to the lateral ligament, which typically involves the foot and ankle just at the moment of loading with a plantarflexion and inversion force. [23][24][25][26][27] Injuries to the medial or deltoid complex accounted for only 14% of ankle sprains. Clanton and Porter 23 stated that medial ligament complex injuries occur in 10% of all ankle sprains; however, their review of ankle sprains included many different sports.…”

“…This may be because functional non-operative treatment is the accepted choice for grade I and grade II ankle sprains. 27 In the case of grade III sprains, the treatment is less clear-that is, whether to immobilise in a cast, to operate, or to allow early controlled mobilisation. Kuwada 9 stated that, when conservative measures have been exhausted and the patient is not satisfied with his or her condition, surgical correction is a reliable and viable treatment.…”

Functional instability in non-contact ankle ligament injuries

“…Controls were recruited from regular users of the Edinburgh University Sports Centre. Patients had sustained a non-contact grade I or II ankle injury, 15 either new or recurrent on the same side, and presented for assessment by the third day after the injury. Participants were aged between 18 and 25.…”

A randomised controlled trial to determine the effectiveness of double Tubigrip in grade 1 and 2 (mild to moderate) ankle sprains

“…It is interesting that the patients in our study required an average of only 3.37 versus 3.21 (DTG versus no DTG) days oV work, which contrasts with the longer times quoted in other studies. 2 3 10 This should not reflect milder injuries, as the same grading system was used, but perhaps may be explained by a diVerence in the patient populations studied. The issues surrounding desire for a rapid return to work are complex and beyond the scope of this study.…”

“…1 Sprains of the lateral anterior talofibular ligament of the ankle are most common and can be classified into three grades of severity, with grade 1 being the least and grade 3 being the most severe. 2 A grade 1 (mild) sprain comprises stretching of the ligament without macroscopic tearing and clinically this leads to little swelling or tenderness, with slight or no functional loss and no mechanical instability of the joint; recovery time is generally about three to seven days. 3 Grade 2 (moderate) sprains are characterised by a partial macroscopic tear of the ligament, leading to moderate pain, swelling and tenderness.…”