Acute Injuries of Lateral Ankle Joint Ligaments

Czech version

Authors: M. Lacko; Z. Sidor ^*; Š. Štolfa; R. Čellár; G. Vaško
Authors‘ workplace: Klinika ortopédie a traumatológie pohybového ústrojenstva Lekárskej fakulty Univerzity Pavla Jozefa Šafárika a Fakultnej nemocnice L. Pasteura v Košiciach, Slovenská republika, prednosta kliniky: doc. MUDr. Gabriel Vaško, CSc. ; Oddelenie urgentného príjmu Fakultnej nemocnice L. Pasteura v Košiciach, Slovenská republika, primár oddelenia: MUDr. Zoltán Sidor, Ph. D. ^*
Published in: Rozhl. Chir., 2010, roč. 89, č. 7, s. 461-465.
Category: Monothematic special - Original

Overview

Acute injuries of the lateral ankle ligaments are one of the most common form of injury involving the musculoskeletal apparatus. Treatment usually range from cast immobilisation or acute surgical repair to functional rehabilitation.

The aim of our study
was to evaluate the incidence of different grades of acute injuries of lateral ligaments of the ankle joint in our patients group and to compare the results of non surgical versus surgical treatment of third grade injuries.

3148 patients were treated for acute lateral ankle sprain in a period of 5 years at our department. Each patient had stress X-ray of the ankle for evaluation of instability at the first visit. From the 234 patients with third grade injury, 39 were enrolled in our study with non surgical treatment and 18 with surgical treatment. Each group was divided regarding to the age in two subgroups. Functional outcome was evaluated 12 and 24 months after injury with AOFAS clinical rating scale and Sports Ankle Rating System – Single Assessment Numeric Evaluation. Statistical analysis was done with Pearson’s Chi quadrate test with P < 0.05.

First grade injury was present in 62%, second grade in 31% and only 7% of the patients had third grade injury of the lateral ankle ligaments. Further only third grade injuries were studied. Statistically significant better results were seen in patients under the age of 25, in the patient group with surgical treatment compared to patients over 25 years of age. Also statistically significant better results were seen in patient with surgical treatment to non surgical treatment in each age group. No significant difference was observed in the non surgical treatment group regarding to age.

Although the injuries of the ankle ligaments belong to the most common injuries of the musculoskeletal system, there is no consensus in the treatment of such disorders.

Our experiences and the results of our study show, that surgical treatment in indicated cases provides better results in residual pain and instability of the ankle joint after acute injury of the lateral ankle ligaments.;

Key words:
ankle joint – subluxation of the talus – lateral ligaments of the ankle – non surgical treatment – surgical treatment

Sources

1. The Dutch College of General Practioners (NHG) Practice quideline: Ankle sprains. January 2000 [cit. 2009-10-15]. Dostupný na WWW: http://nhg.artsennet.nl/upload/104/guidelines2/E04.htm.

2. Kerkhoffs, G. M. H. J., Handoll, H. H. G., De Bie, R., Rowe, B. H., Struijs, P. A. A. Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane database of systematic rewiews, 2006; 2. Art. No.: CD000380. DOI: 10.1002/14651858.CD000380.pub2.

3. Kannus, P., Renstrom, P. Treatment for acute tears of lateral ligaments of the ankle. J. Bone Joint Surg. Am., 1991; 73: 305–312.

4. Stiell, I. G., McKnight, R. D., Greenbeng, G. H., McDowell, I., Nair, R. C., Wells, G. A. Implementation of the Ottawa ankle rules. JAMA, 1994; 271: 827–832.

5. Gaebler, C., Kukla, C., Breitenseher, M. J., Nellas, Z. J., Mittlboeck, M., Trattnig, S., Vecsei, V. Diagnosis of lateral ankle ligament injuries. Comparison between talar tilt, MRI and operative findings in 112 athletes. Acta Orthop. Scan., 1997; 3: 286–290.

6. Kreitner, K. F., Ferber, A:, Grebe, P., Runkel, M., Berger, S., Thelen, M. Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging. Eur. Radiol., 1999; 9: 519–524.

7. Beynnon, B. D., Renstrom, P. A., Haugh, L.,Uh, B. S.,Barker, H. A prospective randomized clinical investigation of the treatment of first-time ankle sprains. Am. J. Spor. Med., 2006; 34: 1401–1412.

8. Lynch, S. A., Renstrom, P. Treatment of acute lateral ankle ligament rupture in the athlete – Conservative versus surgical treatment. Sports Med., 1999; 27: 61–71.

9. Kaikkonen, A., Hyppänen, E., Kannus, P., Järvinen, M. Long-term functional outcome after primary repair of the lateral ligaments of the ankle. Am. Sport Med., 1997; 25: 150–155.

10. Pijnenburg, A. C. M., van Dijk, C. N., Bossuyt, P. M. M., Marti, R. K. Treatment of ruptures of the lateral ankle ligaments: A meta-analysis. J. Bone Joint Surg. Am., 2000; 82: 761–773.

11. Povacz, P., Unger, F., Miller, K., Tockner, R., Resch, H. A randomized, prospective study of operative and non-operative treatement of injuries of the fibular collateral ligaments of the ankle. J. Bone Joint Surg. Am., 1998; 80: 345–351.

12. Specchiulli, F., Scialpi, L, Solarino, G., Grano, G. F.,Casto, A. Comparison of surgery, cast immobilization and taping in the treatment of grade III ankle sprains. J. Sport. traumatol.,1997; 19: 1–6.

13. Specchiulli, F., Cofano, R. E. A comparison of surgical and conservative treatment in ankle ligament tears. Orthopedics, 2001; 24: 686–688.

14. Vojtaššak, J. Ortopédia a traumatológia, Bratislava, SAP Litera Medica, 2006: 518–521.

15. Baumhauer, J., O’Brien, T. Surgical Considerations in the Treatment of Ankle Instability. J. Athl. Train., 2002; 37(4): 458–462.

16. Thacker, S. B., Stroup, D. F., Branche, C. M., Gilchrist, J., Goodman, R. A., Weitman, E. A. The prevention of ankle sprains in sports. A systematic review of the literature. Am. J. Sports Med., 1999; 27: 753–760.

17. Wolfe, M. W., Uhl, T. L., Mattacola, C. G., McCluskey, L. C. Management of Ankle Sprains. Am. Fam. Physician, 2001; 1: 1–14.

18. Frei, R., Biosca, F. E, Handl, M., Trč, T. Konzervativní terapie poranění ligamentózního aparátu hlezna s využitím PRGF. Acta Chir. Orthop. Tr., 2008; 75: 28–33.

19. Talal Ibrahim, T., Beiri, A., Azzabi, M., Best, A. J., Taylor, G. J., Menon, D. K. Reliability and Validity of the Subjective Component of the American Orthopaedic Foot and Ankle Society Clinical Rating Scales. The Journal of Foot and ankle Surgery, 2007; 46: 65–74

20. Williams, G. N., Molloy, J. M., DeBerardino, T. M., Arciero, R. A., Taylor, D. C. Evaluation of the Sports Ankle Rating System in young, athletic individuals with acute lateral ankle sprains. Foot Ankle Int., 2003; 24: 274–282.

21. Kerkhoffs, G. M. M. J., Rowe, B. H., Assendelft, W. J. J., Kelly, K. D., Struijs, P. A. A., van Dijk, C. N. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003762. DOI: 10.1002/14651858.CD003762.

22. Anandacoomarasamy, A., Barnsley, L. Long termoutcomes of inversion ankle injuries. Brit. J. Sport. Med., 2005; 39: e14.