Lateral Ligament Instability: Review of Pathology and Diagnosis

Abstract

Purpose of Review Ankle sprains are a common injury that can lead to chronic lateral ankle instability resulting in pain, poor function, and decreased quality of life. The purpose of this review is to present information regarding injury mechanisms to the lateral ligaments of the ankle and the necessary steps to appropriately diagnose lateral ligament instability. Recent Findings The literature demonstrates that history and physical examination is often a reliable method for diagnosis of lateral ankle instability. In addition, imaging modalities are often used as adjuncts for diagnosis, especially when physical exam findings are equivocal. Summary In summary, chronic lateral ligament instability of the ankle occurs secondary to failure of the lateral ligamentous complex. A focused physical examination to evaluate the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament is necessary for diagnosis. Imaging modalities including plain radiographs, stress radiographs, and MRI are helpful for definitive diagnosis and to rule out other pathology.

Ankle and Foot

“…It has an intra-articular but extra-synovial location and blends with the posterior capsule. On MR imaging, it appears as a strong, often fan-shaped structure with a striated appearance due to fibrofatty composition [16][17][18].…”

“…Isolated tears of the CFL are rare, and injuries of the PTFL almost never occur unless following gross dislocation of the ankle. Typical sites of ATFL and CFL tears are the mid-substance of the ligaments or their insertions to the talus and calcaneus [16,17].…”

“…Osseous avulsion can be overlooked, in particular if the bony fragment is small, and therefore, correlation with conventional radiography is mandatory. Associated injuries can include osteochondral lesions of the talus; injury to the medial collateral ligament complex, the tibiofibular syndesmosis, the bifurcate ligament, and the ligaments of the tarsal sinus; and peroneal tendon lesions, as well as fractures [16][17][18].…”

Biomechanical Characteristics of the Support Leg During Side-Foot Kicking in Soccer Players With Chronic Ankle Instability

“…CAI, chronic ankle instability; FFHFA, angle of the forefoot with respect to the hindfoot; GRF, groundreaction force; HFTBA, angle of the hindfoot with respect to the tibia; MD, mean difference. Studies have proposed that the instability of the ankle joint is caused by a lack of primary neuromuscular conditioning, 14,15 involving the ligaments and intrinsic foot muscles in the ankle, 21,30,34 or lower extremity malalignment. 39 Hence, it is considered that the static and dynamic stabilizers of the ankle joint play important roles in dynamic and static postural control during landing.…”

“…Studies have proposed that the instability of the ankle joint is caused by a lack of primary neuromuscular conditioning, 14 , 15 involving the ligaments and intrinsic foot muscles in the ankle, 21 , 30 , 34 or lower extremity malalignment. 39 Hence, it is considered that the static and dynamic stabilizers of the ankle joint play important roles in dynamic and static postural control during landing.…”