Lateral Ankle Sprain and Chronic Ankle Instability

Abstract

A select 10-30% of patients with recurrent lateral ankle sprains develop chronic ankle instability (CAI). Patients with chronic ankle instability describe a history of the ankle "giving way" with or without pathological laxity on examination. Evaluation includes history, identification of predisposing risk factors for recurrent sprains, and the combination of clinical tests (eg, laxity tests) with imaging to establish the diagnosis. There are a variety of nonoperative strategies to address chronic ankle instability, which include rehabilitation and taping or bracing to prevent future sprains. Patients who fail conservative treatment are candidates for surgery. The anatomic approaches (eg, modified Broströ m) are preferred to nonanatomic procedures since they recreate the ankle's biomechanics and natural course of the attenuated ligaments. There is a growing interest in minimally invasive procedures via ankle arthroscopy that also address the associated intra-articular disorders. This article provides a review of chronic lateral ankle instability consisting of relevant anatomy, associated disorders, evaluation, treatment methods, and complications.

Chronic lateral ankle instability: a current concepts review

“…4,7 This supports the concept of initial conservative management and surgery being reserved for failed conservative management. 17 The concept of rotational ankle instability (RAI) has been described by Buchhorn et al and Vega et al as a combination of lesions in the medial (anterior deltoid ligament) and lateral ligament complex. The condition is defined as an abnormal increase of talar rotation within the tibiofibular mortise due to an injury in the most anterior component of the deltoid ligament secondary to a chronic deficiency of the lateral collateral ligaments.…”

“…Aerobic fitness is maintained with crosstraining. 7,17,30 Activity-specific exercises with progression from low level to full activity specific exercises are started from week 10. 29 In the chronic setting, the emphasis has been on initial nonoperative management, with most studies stating that patients receive full conservative management before surgery is considered.…”

“…Since the inferior retinaculum attaches to the calcaneus distally, by advancing it onto the fibula, the subtalar joint is also stabilised. 17,33,34 Over the years, many modifications have been made to the Broström technique and many different augments have also been used. One of the more recently described is the Internal Brace ® (Arthrex, Naples, FL).…”

Stabilizacija gležnja fibularnim periostealnim režnjem u liječenju kronične lateralne nestabilnosti gležnja

“…Talar tilt test izvodi se zadržavajući gležanj u dorzalnoj fleksiji i forsiranjem pozicioniranja pete i talusa u inverzijski položaj. Ovim testom evaluira se CFL 7,11,14,16,17 .…”

“…Lateralni ligamentarni kompleks čine prednji talofibularni ligament (ATFL), kalkaneofibularni ligament (CFL) i stražnji talofibularni ligament (PTFL) (slika 1a). Prednji talofibularni ligament polazi s anteroinferiornog ruba fibule i završava na proksimal-CFL nešto rjeđe, a PTFL biva ozlijeđen u manje od 10 % ovakvih uganuća 6,7 . Važno je naglasiti da jedino CFL od svih ligamenata lateralnog ligamentarnog kompleksa ima značajnu ulogu u stabi lizaciji subtalarnog zgloba, koji također može biti zahvaćen uganućem.…”