search for




 

Acute ankle lateral ligament injury: an up-to-date review
Arthrosc Orthop Sports Med 2023;10:1-9
Published online May 1, 2023;  https://doi.org/10.14517/aosm23002
© 2023 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Sung Hyun Lee1,2, Min Seok Kim1

1Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, 2Musculoskeletal and Immune Disease Research Institute, Wonkwang University, Iksan, Korea
Correspondence to: Sung Hyun Lee, https://orcid.org/0000-0001-6468-1456
Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan 54538, Korea. Tel: +82-63-859-1360, Fax: +82-63-852-9329, E-mail: kensin06@hanmail.net
Received March 2, 2023; Revised April 6, 2023; Accepted April 7, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Ankle lateral ligament injuries are common in everyday life and sports. Because most lateral ankle ligament injuries occur during sports, proper diagnosis, treatment, and rehabilitation are critical to the patient’s prognosis. A physical examination is necessary for determining ankle injuries. Radiographic examinations include radiography, ultrasonography, and magnetic resonance imaging (MRI), and there are differing views on these tools. The goal of treatment for acute ankle lateral ligament injuries is to prevent chronic ankle instability. Exercise and bracing are more evidenced-based recommendations that should be incorporated into the rehabilitation process. A comprehensive and progressive exercise program should include range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Many systematic reviews have found insufficient evidence to support the clinical usefulness and necessity of primary surgical repair for acute lateral ankle sprains. Surgical treatment for acute lateral ankle sprain without concomitant pathologies is not recommended and should only be considered in cases of severe injury with large bony avulsion or frank dislocation or professional athletes with complete ligament rupture (Grade III) and severe instability.
Keywords : Ankle; Diagnosis; Sprain; Treatment
References
  1. Halabchi F, Hassabi M. Acute ankle sprain in athletes: clinical aspects and algorithmic approach. World J Orthop 2020;11:534-58.
    Pubmed KoreaMed CrossRef
  2. Richardson DR. Sports injuries of the ankle. In: Azar FM, Beaty JH, Canale ST, Campbell WC, editors. Campbell’s operative orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021. p.4495-36. e5.
  3. Ferran NA, Maffulli N. Epidemiology of sprains of the lateral ankle ligament complex. Foot Ankle Clin 2006;11:659-62.
    Pubmed CrossRef
  4. Smith RW, Reischl SF. Treatment of ankle sprains in young athletes. Am J Sports Med 1986;14:465-71.
    Pubmed CrossRef
  5. Clanton TO, Schon LC. Athletic injuries to the soft tissues of the foot and ankle. In: Coughlin MJ, Saltzman CL, Anderson RB, editors. Mann’s surgery of the foot and ankle. 9th ed. Philadelphia, PA: Saunders/Elsevier; 2013. p.1555-70.
  6. Dias LS. The lateral ankle sprain: an experimental study. J Trauma 1979;19:266-9.
    Pubmed CrossRef
  7. St Pierre R, Allman F Jr, Bassett FH 3rd, Goldner JL, Fleming LL. A review of lateral ankle ligamentous reconstructions. Foot Ankle 1982;3:114-23.
    Pubmed CrossRef
  8. Larkins LW, Baker RT, Baker JG. Physical examination of the ankle: a review of the original orthopedic special test description and scientific validity of common tests for ankle examination. Arch Rehabil Res Clin Transl 2020;2:100072.
    Pubmed KoreaMed CrossRef
  9. Broström L. Sprained ankles. 3. Clinical observations in recent ligament ruptures. Acta Chir Scand 1965;130:560-9.
  10. Lau BC, Moore LK, Thuillier DU. Evaluation and management of lateral ankle pain following injury. JBJS Rev 2018;6:e7.
    Pubmed CrossRef
  11. Barelds I, Krijnen WP, van de Leur JP, van der Schans CP, Goddard RJ. Diagnostic accuracy of clinical decision rules to exclude fractures in acute ankle injuries: systematic review and metaanalysis. J Emerg Med 2017;53:353-68.
    Pubmed CrossRef
  12. Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med 2009;16:277-87.
    Pubmed CrossRef
  13. Milz P, Milz S, Steinborn M, Mittlmeier T, Putz R, Reiser M. Lateral ankle ligaments and tibiofibular syndesmosis. 13-MHz highfrequency sonography and MRI compared in 20 patients. Acta Orthop Scand 1998;69:51-5.
    Pubmed CrossRef
  14. Peetrons P, Creteur V, Bacq C. Sonography of ankle ligaments. J Clin Ultrasound 2004;32:491-9.
    Pubmed CrossRef
  15. Kaminski TW, Hertel J, Amendola N, et al. National Athletic Trainers’ Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train 2013;48:528-45.
    Pubmed KoreaMed CrossRef
  16. Polzer H, Kanz KG, Prall WC, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia) 2012;4:e5.
    CrossRef
  17. Chen ET, Borg-Stein J, McInnis KC. Ankle sprains: evaluation, rehabilitation, and prevention. Curr Sports Med Rep 2019;18:217-23. Erratum in: Curr Sports Med Rep 2019;18:310.
    Pubmed CrossRef
  18. Kim JS, Moon YJ, Choi YS, Park YU, Park SM, Lee KT. Usefulness of oblique axial scan in magnetic resonance imaging evaluation of anterior talofibular ligament in ankle sprain. J Foot Ankle Surg 2012;51:288-92.
    Pubmed CrossRef
  19. Park HJ, Lee SY, Choi YJ, et al. 3D isotropic T2-weighted fast spin echo (VISTA) versus 2D T2-weighted fast spin echo in evaluation of the calcaneofibular ligament in the oblique coronal plane. Clin Radiol 2017;72:176.e1-7.
    Pubmed CrossRef
  20. Park HJ, Lee SY, Park NH, Kim E, Chung EC, Kook SH, Lee JW. Usefulness of the oblique coronal plane in ankle MRI of the calcaneofibular ligament. Clin Radiol 2015;70:416-23.
    Pubmed CrossRef
  21. O’Donoghue DH. Treatment of ankle injuries. Northwest Med 1958;57:1277-86.
  22. Jackson DW, Ashley RL, Powell JW. Ankle sprains in young athletes. Relation of severity and disability. Clin Orthop Relat Res 1974;(101):201-15.
  23. Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 2018;52:956.
    Pubmed CrossRef
  24. Bleakley CM, McDonough SM, MacAuley DC, Bjordal J. Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. Br J Sports Med 2006;40:700-5; discussion 705.
    Pubmed KoreaMed CrossRef
  25. Coté DJ, Prentice WE Jr, Hooker DN, Shields EW. Comparison of three treatment procedures for minimizing ankle sprain swelling. Phys Ther 1988;68:1072-6.
    Pubmed CrossRef
  26. Hubbard TJ, Aronson SL, Denegar CR. Does cryotherapy hasten return to participation? A systematic review. J Athl Train 2004;39:88-94.
  27. Smith RW, Reischl S. The influence of dorsiflexion in the treatment of severe ankle sprains: an anatomical study. Foot Ankle 1988;9:28-33.
    Pubmed CrossRef
  28. Beynnon BD, Renström PA, Haugh L, Uh BS, Barker H. A prospective, randomized clinical investigation of the treatment of firsttime ankle sprains. Am J Sports Med 2006;34:1401-12.
    Pubmed CrossRef
  29. Petersen W, Rembitzki IV, Koppenburg AG, et al. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg 2013;133:1129-41.
    Pubmed KoreaMed CrossRef
  30. Seah R, Mani-Babu S. Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence. Br Med Bull 2011;97:105-35.
    Pubmed CrossRef
  31. Omori G, Kawakami K, Sakamoto M, Hara T, Koga Y. The effect of an ankle brace on the 3-dimensional kinematics and tibio-talar contact condition for lateral ankle sprains. Knee Surg Sports Traumatol Arthrosc 2004;12:457-62.
    Pubmed CrossRef
  32. Cho BK. Evidence-based treatment of acute lateral ankle sprain. J Korean Foot Ankle Soc 2018;22:135-44.
    CrossRef
  33. Ardèvol J, Bolíbar I, Belda V, Argilaga S. Treatment of complete rupture of the lateral ligaments of the ankle: a randomized clinical trial comparing cast immobilization with functional treatment. Knee Surg Sports Traumatol Arthrosc 2002;10:371-7.
    Pubmed CrossRef
  34. Houglum PA. Soft tissue healing and its impact on rehabilitation. J Sport Rehabil 1992;1:19-39.
    CrossRef
  35. Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly KD, Struijs PA, van Dijk CN. Immobilisation for acute ankle sprain. A systematic review. Arch Orthop Trauma Surg 2001;121:462-71.
    Pubmed CrossRef
  36. Hupperets MD, Verhagen EA, van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ 2009;339:b2684.
    Pubmed KoreaMed CrossRef
  37. Naeem M, Rahimnajjad MK, Rahimnajjad NA, Idrees Z, Shah GA, Abbas G. Assessment of functional treatment versus plaster of Paris in the treatment of grade 1 and 2 lateral ankle sprains. J Orthop Traumatol 2015;16:41-6.
    Pubmed KoreaMed CrossRef
  38. Kerkhoffs GM, Struijs PA, Marti RK, Assendelft WJ, Blankevoort L, van Dijk CN. Different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev 2002;(3):CD002938.
    CrossRef
  39. Maffulli N, Ferran NA. Management of acute and chronic ankle instability. J Am Acad Orthop Surg 2008;16:608-15.
    Pubmed CrossRef
  40. McCriskin BJ, Cameron KL, Orr JD, Waterman BR. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations. World J Orthop 2015;6:161-71.
    Pubmed KoreaMed CrossRef
  41. Guillo S, Bauer T, Lee JW, et al. Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. Orthop Traumatol Surg Res 2013;99(8 Suppl):S411-9.
    Pubmed CrossRef
  42. Tourné Y, Mabit C. Lateral ligament reconstruction procedures for the ankle. Orthop Traumatol Surg Res 2017;103 (1 Suppl):S171-81.
    Pubmed CrossRef
  43. Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev 2007;(2):CD000380.
    Pubmed CrossRef


May 2024, 11 (1)