The aim of the study was to introduce and evaluate a standardized test protocol and scoring scale for evaluation of ankle injuries. After evaluation of 11 different functional ankle tests, questionnaire answers, and results of clinical ankle examination, the final test protocol consisted of 3 simple questions describing the subjective assessment of the injured ankle, 2 clinical measurements (range of motion in dorsiflexion, laxity of the ankle joint), 1 ankle test measuring functional stability (walking down a staircase), 2 tests measuring muscle strength (rising on heels and toes), and 1 test measuring balance (balancing on a square beam). Each selected test showed excellent reproducibility when tested with a reference group of 100 uninjured persons. According to the test results of a population of 148 patients with an operatively treated grade III lateral ligament injury of the ankle, each test could significantly differentiate healthy controls and patients with excellent overall healing from those with poor or fair recovery. The final total test score correlated significantly with the isokinetic strength results of the ankle, subjective opinion about the recovery, and subjective-functional assessment. The scale presented is recommended for studies evaluating functional recovery after ankle injury.

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We retrospectively reexamined a total of 100 patients 6 to 8 years after primary repair of ruptured lateral ligaments of the ankle. Fifty-nine percent of the injuries had occurred in sports; the other main causes of the injuries were accidents at work (12%), in traffic (10%), and at home (4%). Almost two-thirds of the sports injuries were sustained in volleyball. The most common type of injury was a combined rupture of the anterior talofibular and the calcaneofibular ligaments (66 patients). According to subjective assessment, 74 patients had excellent or good results. For the anterior drawer sign test, 75 patients showed no sign of instability in their injured ankles. The scores in our performance test protocol of ankle injuries were classified as excellent or good in 65 patients, fair in 27 patients, and poor in 8 patients. The overall long-term results were acceptable in the majority of the patients. Prospective, randomized studies are needed to clarify if nonoperative treatment (i.e., early controlled mobilization) would give similar long-term results.

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