Surgical Management of Lateral Ankle Instability in Athletes

Abstract

Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.

Regeneration of grade 3 ankle sprain, using the recombinant human amelogenin protein (rHAM+) in a rat model

“…Ankle sprains, injuries of the lateral ligamentous complex that stabilizes the ankle joint, are very common injuries and the most common athletic injury 1‐5 . They are painful and debilitating, associated with considerable healthcare consumption and socioeconomic costs 1,6 .…”

Medial Patellofemoral Complex Advancement for Recurrent Lateral Patellar Instability and Selective Acute Primary Patellar Dislocations

“…MPFL reconstruction, on the other hand, is equivalent to peroneal tendon nonanatomic reconstructions (like the Watson Jones procedure), which results in suboptimal outcomes in ankle instability. 17 Major advantages of MPFC advancement are its anatomical nature of restoration of medial restraints, the simplicity of the procedure, and that it can be reproduced in patients with open physis without any concern of growth plates. Furthermore, MPFC advancement avoids multiple shortcomings associated with MPFL reconstruction.…”

“…MPFC advancement can be considered analogous to the Karlsson modification of the Brostrom procedure for ankle instability. 17 Conceptually, MPFL can be equated to the anterior talofibular ligament, in the sense that they both are thin sheet-like structures and heal after injury in an elongated lax state. Similar to the Karlsson modification, the capsuloligamentous complex is mobilized as a whole for advancement, and a bone to ligament healing is intended in this procedure.…”

“…MPFL reconstruction, on the other hand, is equivalent to peroneal tendon nonanatomic reconstructions (like the Watson Jones procedure), which results in suboptimal outcomes in ankle instability. 17 …”

Arthroscopic Remnant-Preserving Anterior Talofibular Ligament Reconstruction does not Improve the Short-term Function of Ankle

“…Therefore, ATFL injury is the most commonly seen in clinic, which will result in CLAI if it is inappropriately treated [12,13]. CLAI accelerates ankle injury and degeneration, which then results in abnormal line of force and arthritis.…”