J Korean Foot Ankle Soc.  2018 Jun;22(2):55-61. 10.14193/jkfas.2018.22.2.55.

Chronic Lateral Ankle Instability

• Kim DW
• Sung KS

• KMID: 2413713
• DOI: http://doi.org/10.14193/jkfas.2018.22.2.55

Abstract

Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients' history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified Broström operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.

Keyword

Ankle; Joint instability; Therapy

MeSH Terms

Ankle Injuries
Ankle Joint
Ankle*
Collateral Ligaments
Humans
Immobilization
Joint Instability
Magnetic Resonance Imaging
Mental Competency
Pathology
Physical Examination
Range of Motion, Articular
Rehabilitation
Sports

Reference

1. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008; 121:324–331.e6..

2. DiGiovanni CW, Brodsky A. Current concepts: lateral ankle instability. Foot Ankle Int. 2006; 27:854–866.

3. Freeman MA. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg Br. 1965; 47:669–677.

4. Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: evolution of the model. J Athl Train. 2011; 46:133–141.

5. Gribble PA, Delahunt E, Bleakley C, Caulfield B, Docherty C, Fourchet F, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2014; 48:1014–1018.

6. Caprio A, Oliva F, Treia F, Maffulli N. Reconstruction of the lateral ankle ligaments with allograft in patients with chronic ankle instability. Foot Ankle Clin. 2006; 11:597–605.

7. Louwerens JW, Ginai AZ, van Linge B, Snijders CJ. Stress radiography of the talocrural and subtalar joints. Foot Ankle Int. 1995; 16:148–155.

8. Cho JH, Lee DH, Song HK, Bang JY, Lee KT, Park YU. Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2016; 24:1022–1028.

9. Maffulli N, Ferran NA. Management of acute and chronic ankle instability. J Am Acad Orthop Surg. 2008; 16:608–615.

10. Ajis A, Maffulli N. Conservative management of chronic ankle instability. Foot Ankle Clin. 2006; 11:531–537.

11. Donovan L, Hertel J. A new paradigm for rehabilitation of patients with chronic ankle instability. Phys Sportsmed. 2012; 40:41–51.

12. Karlsson J, Lansinger O. [Lateral instability of the ankle joint (1). Non-surgical treatment is the first choice--20 per cent may need ligament surgery]. Lakartidningen. 1991; 88:1399–1402. Swedish.

13. Karlsson J, Bergsten T, Lansinger O, Peterson L. Surgical treatment of chronic lateral instability of the ankle joint. A new procedure. Am J Sports Med. 1989; 17:268–273. discussion 273-4.

14. Karlsson J, Eriksson BI, Bergsten T, Rudholm O, Swärd L. Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint. Am J Sports Med. 1997; 25:48–53.

15. Cho BK, Kim YM, Kim DS, Choi ES, Shon HC, Park KJ. Comparison between suture anchor and transosseous suture for the modified-Broström procedure. Foot Ankle Int. 2012; 33:462–468.

16. Lee KT, Lee JI, Sung KS, Kim JY, Kim ES, Lee SH, et al. Biomechanical evaluation against calcaneofibular ligament repair in the Brostrom procedure: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2008; 16:781–786.

17. Jeong BO, Kim MS, Song WJ, SooHoo NF. Feasibility and outcome of inferior extensor retinaculum reinforcement in modified Broström procedures. Foot Ankle Int. 2014; 35:1137–1142.

18. Corte-Real NM, Moreira RM. Arthroscopic repair of chronic lateral ankle instability. Foot Ankle Int. 2009; 30:213–217.

19. Guelfi M, Zamperetti M, Pantalone A, Usuelli FG, Salini V, Oliva XM. Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability: a systematic review. Foot Ankle Surg. 2018; 24:11–18.

20. Kerkhoffs GM, Kennedy JG, Calder JD, Karlsson J. There is no simple lateral ankle sprain. Knee Surg Sports Traumatol Arthrosc. 2016; 24:941–943.

21. Shakked RJ, Karnovsky S, Drakos MC. Operative treatment of lateral ligament instability. Curr Rev Musculoskelet Med. 2017; 10:113–121.

22. Schenck RC Jr, Coughlin MJ. Lateral ankle instability and revision surgery alternatives in the athlete. Foot Ankle Clin. 2009; 14:205–214.

23. Matheny LM, Johnson NS, Liechti DJ, Clanton TO. Activity level and function after lateral ankle ligament repair versus reconstruction. Am J Sports Med. 2016; 44:1301–1308.

24. Sha Y, Wang H, Ding J, Tang H, Li C, Luo H, et al. A novel patient-specific navigational template for anatomical reconstruction of the lateral ankle ligaments. Int Orthop. 2016; 40:59–64.

25. Vuurberg G, Pereira H, Blankevoort L, van Dijk CN. Anatomic stabilization techniques provide superior results in terms of functional outcome in patients suffering from chronic ankle instability compared to non-anatomic techniques. Knee Surg Sports Traumatol Arthrosc. 2017; 11. 14. DOI: 10.1007/s00167-017-4730-4.

26. Park JS, Kim BS. Risk factors for failure after lateral ankle ligament repair. J Korean Foot Ankle Soc. 2016; 20:62–66.

27. Viens NA, Wijdicks CA, Campbell KJ, Laprade RF, Clanton TO. Anterior talofibular ligament ruptures, part 1: biomechanical comparison of augmented Broström repair techniques with the intact anterior talofibular ligament. Am J Sports Med. 2014; 42:405–411.

28. Cho BK, Park KJ, Park JK, SooHoo NF. Outcomes of the modified Broström procedure augmented with suture-tape for ankle instability in patients with generalized ligamentous laxity. Foot Ankle Int. 2017; 38:405–411.

29. Knop C, Knop C, Thermann H, Blauth M, Bastian L, Zwipp H, et al. [Treatment of recurrence of fibular ligament rupture. Results of a prospective randomized study]. Unfallchirurg. 1999; 102:23–28. German.

30. Pearce CJ, Tourné Y, Zellers J, Terrier R, Toschi P, Silbernagel KG, et al. Rehabilitation after anatomical ankle ligament repair or reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016; 24:1130–1139.