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Unsatisfactory outcomes after conservative treatment for proximal migration of acute calcaneal-side calcaneofibular ligament rupture in athletes: a preliminary report
Arthrosc Orthop Sports Med 2021;8:9-14
Published online May 1, 2021;
© 2021 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Jin Su Kim, Sang Bum Kim, Min Seok Cha

Foot and Ankle Clinic, Department of Orthopedic Surgery, Sejong Sports Medicine & Performance Center, Seoul, Korea
Correspondence to: Jin Su Kim,
Foot and Ankle Clinic, Department of Orthopedic Surgery, Sejong Sports Medicine & Performance Center, Daeyang AI center, Sejong University, Neugdong-ro 209, Gwangjin-gu, Seoul 05006, Korea. Tel: +82-2-2244-5161, Fax: +82-2-2244-6171, E-mail:
Received March 20, 2021; Revised March 23, 2021; Accepted April 4, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Acute ankle ligament rupture is usually treated conservatively. However, it sometimes progresses to chronic ankle instability. We suspected that there is a tendency for calcaneal-side calcaneofibular ligament (CFL) ruptures to progress to chronic ankle instability.
Methods: Fourteen athletes with calcaneal-side CFL ruptures who were treated conservatively and followed for a mean period of 35.2 months were included in the study. Proximal migration of the stump of CFL (mm) was evaluated using magnetic resonance imaging at a 45° oblique coronal plane. A Stener lesion was defined as severe migration outside the peroneal tendon. The results of manual anterior drawer, varus stress tests, and stress radiographs at the initial and final follow-up visits were compared. The time to return to running, team training, and sporting competitions were recorded. At the final follow-up, patient satisfaction and Cumberland Ankle Instability Tool (CAIT) were used to assess ankle function.
Results: The mean proximal migration of CFL was 11.2 mm. Four Stener lesions were found. However, neither proximal migration nor Stener lesions were significantly related to CAIT scores (rho = 0.288 and rho = 0.082, respectively). Ankle instability significantly decreased after conservative treatment from a mean grade of 2.0 to 1.4 in the anterior drawer test (P = 0.032). The varus stress test results showed a decrease from grade 2.2 to 1.8 (P = 0.053) without significance. Radiologically, decreases in anterior translation from 6.1 mm to 5.4 mm (P = 0.205) and talar tilt angles from 7.2° to 6.5° (P = 0.500) were observed without significance. It took 12.2, 14.7, and 18.0 weeks to return to running, team training, and sporting competitions, respectively. Seven athletes (50%) reported unsatisfactory results.
Conclusion: Conservative treatment for CFL rupture with proximal migration was associated with poor outcomes in athletes.
Keywords : Calcaneofibular ligament; Rupture; Conservative treatment; Poor outcome
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