· partial or complete rupture of one or parts of lateral ligament of ankle
· syn. ankle sprain
· most commonly involves young males
· average age 27
· M:F 2.5:1
· common injury in sport
· 20% of sporting injuries
· common in basketball and soccer
· inversion injury
· predisposed by
· peroneal muscle weakness
· pes cavus
· lateral ligament complex composed of
· anterior talofibular lig.
· calcaneofibular lig.
· posterior talofibular lig.
· ligaments under strain when ankle inverted
· ATF under increased strain when ankle plantarflexed and internally rotated
· CF under increased strain when ankle dorsiflexed
· PTF under increased strain when ankle dorsiflexed and externally rotated
· injury most often occurs when ankle plantarflexed and internally rotated
· thus ruptures involve
· isolated ATF (70%)
· combination of ATF and CF (30%)
· CF alone (rare)
· PTF (rare)
Grade 1
· stretch without macroscopic tear
· little pain, swelling or tenderness
· slight or no functional loss
· no instability
Grade 2
· partial tear
· moderate pain, swelling and tenderness
· some loss of motion
· mild or moderate instability
· usually is isolated ATF tear
Grade 3
· complete tear
· severe pain, swelling and tenderness
· significant loss of function
· moderate or severe instability
· usually is combined ATF and CF tear
· history of going over or twisting
· may be palpable pop
· pain and swelling on lateral ankle
· tenderness and swelling over involved structure
· ATF - anterior to lateral malleolus
· CF - inferior to lateral malleolus
· instability difficult to elicit because of pain
· usually normal
· may be osteochondral fracture of medial talus
· may be avulsion fracture of lateral malleolus
· stress views difficult to obtain because of pain
· three options
· cast immobilisation
· function treatment (strapping and early controlled mobilisation)
· operative repair
· method of choice
Technique
· immediate ice and elevation
· early weight bearing protected by short period of strapping or bracing
· early programme of
· ROM
· strengthening
· proprioception
Results
· metanalysis performed
· functional treatment superior in
· time to return to work or physical activity
· achievement of ROM
· avoidance of muscle wasting
· complications
· no difference in
· instability (giving way)
· pain, swelling and stiffness with activity
· reinjury
· mechanical stability
· limited indications
· large avulsions of bone
· severe ligamentous damage to both sides of joint
· recurrent injury
· instability due to rupture of one or more parts of lateral ligament
· complain of
· pain and swelling over anterolateral ankle
· giving way
· occurs with
· activity
· walking on uneven ground
Local
· tenderness and swelling over involved ligaments
· anterior to lateral malleolus for ATF
· inferior to lateral malleolus for CF
Instability
· depends on ligaments involved
· ATF instability
· anterior subluxation on anterior drawer of talus on tibia with ankle in neutral
· increased inversion on varus stress with ankle in plantarflexion
· CF instability
· increased inversion on varus stress with ankle in dorsiflexion
· ATF and CF instability
· increased inversion on varus stress in all positions of ankle
· anterior drawer
· positive if > 3 mm
· lateral tilt
· positive if > 10o-20o (grey zone)
· plain x-ray usually normal
· may be osteochondral fracture on medial aspect of talus
· stress radiographs often diagnostic
· anterior talar subluxation on anterior drawer
· lateral talar tilt on varus stress
· rehabilitation programme
· concentration on stengthening of peroneal tendons
· shoewear modification
· laterally flared heel
· for failed rehabilitation
· various techniques
· modified Brostrum procedure is procedure of choice