DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20185144

Do we need early ankle arthroscopy for the patients with acute lateral ankle instability

Ahmet Yildirim, Mustafa Özer

Abstract


Background: Lateral ankle injury is the most frequently encountered trauma in physically active populations. The general approach to acute lateral ankle instabilities is conservative treatment.

Methods: We investigated the effects of compliance to conservative treatment on permanent instability and other intra-articular pathologies and the outcomes of insufficiently treated lateral ankle instability. These patients underwent conservative treatment for at least 3 months. At the end of this period, anterior ankle arthroscopy was performed for patients who continued to report ankle problems. The patients were grouped according to compliance and noncompliance with conservative treatment.

Results: The rate of compliance for conservative treatment was 41.4%. Arthroscopy revealed that the rate of osteochondral lesions of the talus was 45.3%; 51.6% of the patients had partial or complete lateral ankle ligament injury. The rate of lateral ankle instability was significantly lower in patients who were compliant with conservative treatment (39.6% vs. 60%, p<0.05). Lateral ankle instability was accompanied by osteochondral defects in only 5 patients who were compliant with conservative treatment.

Conclusions: For ankle injuries associated with lateral ankle instability, conservative treatment can decrease instability levels and other pathologies, which may become chronic over time. However, arthroscopy may be required due to ankle pathologies accompanying instability and an early decision for arthroscopy may reduce the incidence of permanent lateral ankle instability.


Keywords


Ankle ligaments, Brace, Conservative treatment, Osteochondral lesion of talus, Rupture, Sprain

Full Text:

PDF

References


Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DT-P, et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 2016;50(24):1496-505.

Kannus P, Renstrom P. Treatment for acute tears of the lateral ligaments of the ankle. J Bone Joint Surg Am. 1991;73(2):305-12.

Hintermann B, Boss A, Schäfer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med. 2002;30(3):402-9.

Řezaninová J, Hrazdira L, Králová DM, Svoboda Z, Benaroya A. Advanced conservative treatment of complete acute rupture of the lateral ankle ligaments: Verifying by stabilometry. Foot and Ankle Surgery. 2017.

Shakked RJ, Karnovsky S, Drakos MC. Operative treatment of lateral ligament instability. Current Rev Musculoskeletal Med. 2017;10(1):113-121.

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(2):161.

Balduini F, Tetzlaff J. Historical perspectives on injuries of the ligaments of the ankle. Clinics Sports Med. 1982;1(1):3-12.

Cameron KL, Owens BD, DeBerardino TM. Incidence of ankle sprains among active-duty members of the United States Armed Services from 1998 through 2006. J Athletic Training. 2010;45(1):29-38.

Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont Jr PJ. The epidemiology of ankle sprains in the United States. JBJS. 2010;92(13):2279-84.

Bleakley CM, McDonough SM, MacAuley DC. Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review. Australian J Physiotherap. 2008;54(1):7-20.

Hertel J. Functional instability following lateral ankle sprain. Sports Med. 2000;29(5):361-71.

Cha SD, Kim HS, Chung ST, Yoo JH, Park JH, Kim JH, et al. Intra-articular lesions in chronic lateral ankle instability: comparison of arthroscopy with magnetic resonance imaging findings. Clinics Orthop Surg. 2012;4(4):293-9.

Kekli̇kçi̇ K, Sahin O, Yıldırım C, Solakoğlu C, Kıral A, Pehlivan O, et al. Treatment of chronic lateral instability of the ankle with the Colville technique: a prospective analysis with minimum five years of follow-up. Eklem Hastalik Cerrahisi. 2012;23(1):35-9.

Bridgman S, Clement D, Downing A, Walley G, Phair I, Maffulli N. Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains. Emergency Med J. 2003;20(6):508-10.

Freeman M, Dean M, Hanham I. The etiology and prevention of functional instability of the foot. Bone Joint J. 1965;47(4):678-85.

van Dijk CN, Bossuyt PM, Marti RK. Medial ankle pain after lateral ligament rupture. J Bone Joint Surg Br. 1996;78(4):562-7.

Stiell I. Ottawa ankle rules. Canadian Family Physician. 1996;42:478.

Karlsson J, Lansinger O. Lateral instability of the ankle joint. Clin Orthop Related Res. 1992(276):253-61.

Malliaropoulos N, Papacostas E, Papalada A, Maffulli N. Acute lateral ankle sprains in track and field athletes: an expanded classification. Foot and ankle clinics. 2006;11(3):497-507.

Prado MP, Mendes AAM, Amodio DT, Camanho GL, Smyth NA, Fernandes TD. A comparative, prospective, and randomized study of two conservative treatment protocols for first-episode lateral ankle ligament injuries. Foot Ankle Int. 2014;35(3):201-6.

Hamilton WG, Thompson FM, Snow SW. The modified Brostrom procedure for lateral ankle instability. Foot Ankle. 1993;14(1):1-7.

Lee M, Kwon JW, Choi WJ, Lee JW. Comparison of outcomes for osteochondral lesions of the talus with and without chronic lateral ankle instability. Foot Ankle Int. 2015;36(9):1050-7.