J Korean Foot Ankle Soc.  2021 Mar;25(1):32-37. 10.14193/jkfas.2021.25.1.32.

Residual Pain after Operative Treatment for Chronic Ankle Instability

• Cho BK
• Ahn BH

• KMID: 2513651
• DOI: http://doi.org/10.14193/jkfas.2021.25.1.32

Abstract

Patients with chronic lateral ankle instability often experience a range of associated injuries. The well-known comorbidities include intra-articular pathologies (osteochondral lesion, soft tissue or bony impingement, and loose body), peroneal tendon pathologies, neural injuries, and other extra-articular pathologies. Surgeons should have a high index of suspicion for these associated pathologies before operative intervention, correlate the clinical findings, and plan the treatment. Despite the restoration of ankle stability following ligament repair or reconstruction surgery, a high prevalence (13%~35%) of postoperative residual pain has been reported. This pain can negatively affect the clinical outcomes and patient satisfaction. This study examined the causes of persistent pain after surgical treatments for chronic ankle instability.

Keyword

Ankle; Instability; Operative treatment; Pain

Reference

1. Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr. 2010; The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 92:2279–84. doi: 10.2106/JBJS.I.01537. DOI: 10.2106/JBJS.I.01537. PMID: 20926721.

2. DiGiovanni CW, Brodsky A. 2006; Current concepts: lateral ankle instability. Foot Ankle Int. 27:854–66. doi: 10.1177/107110070602701019. DOI: 10.1177/107110070602701019. PMID: 17054892.

3. Hubbard TJ. 2008; Ligament laxity following inversion injury with and without chronic ankle instability. Foot Ankle Int. 29:305–11. doi: 10.3113/FAI.2008.0305. DOI: 10.3113/FAI.2008.0305. PMID: 18348827.

4. O'Loughlin PF, Murawski CD, Egan C, Kennedy JG. 2009; Ankle instability in sports. Phys Sportsmed. 37:93–103. doi: 10.3810/psm.2009.06.1715. DOI: 10.3810/psm.2009.06.1715. PMID: 20048515.

5. Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DT, et al. 2016; Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med. 50:1496–505. doi: 10.1136/bjsports-2016-096189. DOI: 10.1136/bjsports-2016-096189. PMID: 27259753.

6. Coughlin MJ, Saltzman CL, Anderson RB. 2014. Mann's surgery of the foot and ankle. 9th ed. Saunders/Elsevier;Philadelphia:

7. Kim HJ. 2014; Conservative management of ankle sprains. J Korean Orthop Assoc. 49:7–12. doi: 10.4055/jkoa.2014.49.1.7. DOI: 10.4055/jkoa.2014.49.1.7.

8. DiGiovanni BF, Fraga CJ, Cohen BE, Shereff MJ. 2000; Associated injuries found in chronic lateral ankle instability. Foot Ankle Int. 21:809–15. doi: 10.1177/107110070002101003. DOI: 10.1177/107110070002101003. PMID: 11128010.

9. Hintermann B, Boss A, Schäfer D. 2002; Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med. 30:402–9. doi: 10.1177/03635465020300031601. DOI: 10.1177/03635465020300031601. PMID: 12016082.

10. Komenda GA, Ferkel RD. 1999; Arthroscopic findings associated with the unstable ankle. Foot Ankle Int. 20:708–13. doi: 10.1177/107110079902001106. DOI: 10.1177/107110079902001106. PMID: 10582846.

11. Okuda R, Kinoshita M, Morikawa J, Yasuda T, Abe M. 2005; Arthroscopic findings in chronic lateral ankle instability: do focal chondral lesions influence the results of ligament reconstruction? Am J Sports Med. 33:35–42. doi: 10.1177/0363546504271058. DOI: 10.1177/0363546504271058. PMID: 15610997.

12. Taga I, Shino K, Inoue M, Nakata K, Maeda A. 1993; Articular cartilage lesions in ankles with lateral ligament injury. An arthroscopic study. Am J Sports Med. 21:120–6. discussion 126–7. doi: 10.1177/036354659302100120. DOI: 10.1177/036354659302100120. PMID: 8427352.

13. Guelfi M, Zamperetti M, Pantalone A, Usuelli FG, Salini V, Oliva XM. 2018; Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability: a systematic review. Foot Ankle Surg. 24:11–8. doi: 10.1016/j.fas.2016.05.315. DOI: 10.1016/j.fas.2016.05.315. PMID: 29413768.

14. Choi WJ, Lee JW, Han SH, Kim BS, Lee SK. 2008; Chronic lateral ankle instability: the effect of intra-articular lesions on clinical outcome. Am J Sports Med. 36:2167–72. doi: 10.1177/0363546508319050. DOI: 10.1177/0363546508319050. PMID: 18669983.

15. Ferkel RD, Chams RN. 2007; Chronic lateral instability: arthroscopic findings and long-term results. Foot Ankle Int. 28:24–31. doi: 10.3113/FAI.2007.0005. DOI: 10.3113/FAI.2007.0005. PMID: 17257534.

16. Gregush RV, Ferkel RD. 2010; Treatment of the unstable ankle with an osteochondral lesion: results and long-term follow-up. Am J Sports Med. 38:782–90. doi: 10.1177/0363546509351556. DOI: 10.1177/0363546509351556. PMID: 20139326.

17. Sugimoto K, Takakura Y, Okahashi K, Samoto N, Kawate K, Iwai M. 2009; Chondral injuries of the ankle with recurrent lateral instability: an arthroscopic study. J Bone Joint Surg Am. 91:99–106. doi: 10.2106/JBJS.G.00087. DOI: 10.2106/JBJS.G.00087. PMID: 19122084.

18. Odak S, Ahluwalia R, Shivarathre DG, Mahmood A, Blucher N, Hennessy M, et al. 2015; Arthroscopic evaluation of impingement and osteochondral lesions in chronic lateral ankle instability. Foot Ankle Int. 36:1045–9. doi: 10.1177/1071100715585525. DOI: 10.1177/1071100715585525. PMID: 26031851.

19. Takao M, Uchio Y, Naito K, Fukazawa I, Ochi M. 2005; Arthroscopic assessment for intra-articular disorders in residual ankle disability after sprain. Am J Sports Med. 33:686–92. doi: 10.1177/0363546504270566. DOI: 10.1177/0363546504270566. PMID: 15722274.

20. Hua Y, Chen S, Li Y, Chen J, Li H. 2010; Combination of modified Broström procedure with ankle arthroscopy for chronic ankle instability accompanied by intra-articular symptoms. Arthroscopy. 26:524–8. doi: 10.1016/j.arthro.2010.02.002. DOI: 10.1016/j.arthro.2010.02.002. PMID: 20362833.

21. Wikstrom EA, Hubbard-Turner T, McKeon PO. 2013; Understanding and treating lateral ankle sprains and their consequences: a constraints-based approach. Sports Med. 43:385–93. doi: 10.1007/s40279-013-0043-z. DOI: 10.1007/s40279-013-0043-z. PMID: 23580392.

22. Valderrabano V, Hintermann B, Horisberger M, Fung TS. 2006; Ligamentous posttraumatic ankle osteoarthritis. Am J Sports Med. 34:612–20. doi: 10.1177/0363546505281813. DOI: 10.1177/0363546505281813. PMID: 16303875.

23. Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N. 2011; Arthroscopic-assisted Broström-Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med. 39:2381–8. doi: 10.1177/0363546511416069. DOI: 10.1177/0363546511416069. PMID: 21803979.

24. O'Neill PJ, Van Aman SE, Guyton GP. 2010; Is MRI adequate to detect lesions in patients with ankle instability? Clin Orthop Relat Res. 468:1115–9. doi: 10.1007/s11999-009-1131-0. DOI: 10.1007/s11999-009-1131-0. PMID: 19851818. PMCID: PMC2835579.

25. Meislin RJ, Rose DJ, Parisien JS, Springer S. 1993; Arthroscopic treatment of synovial impingement of the ankle. Am J Sports Med. 21:186–9. doi: 10.1177/036354659302100204. DOI: 10.1177/036354659302100204. PMID: 8465910.

26. Lee JW, Suh JS, Huh YM, Moon ES, Kim SJ. 2004; Soft tissue impingement syndrome of the ankle: diagnostic efficacy of MRI and clinical results after arthroscopic treatment. Foot Ankle Int. 25:896–902. doi: 10.1177/107110070402501209. DOI: 10.1177/107110070402501209. PMID: 15680103.

27. Staats K, Sabeti-Aschraf M, Apprich S, Platzgummer H, Puchner SE, Holinka J, et al. 2018; Preoperative MRI is helpful but not sufficient to detect associated lesions in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc. 26:2103–9. doi: 10.1007/s00167-017-4567-x. DOI: 10.1007/s00167-017-4567-x. PMID: 28508294. PMCID: PMC6061436.

28. Wang DY, Jiao C, Ao YF, Yu JK, Guo QW, Xie X, et al. 2020; Risk factors for osteochondral lesions and osteophytes in chronic lateral ankle instability: a case series of 1169 patients. Orthop J Sports Med. 8:2325967120922821. doi: 10.1177/2325967120922821. DOI: 10.1177/2325967120922821. PMID: 32518802. PMCID: PMC7252382.

29. Mologne TS, Ferkel RD. 2007; Arthroscopic treatment of osteochondral lesions of the distal tibia. Foot Ankle Int. 28:865–72. doi: 10.3113/FAI.2007.0865. DOI: 10.3113/FAI.2007.0865. PMID: 17697650.

30. Lee J, Hamilton G, Ford L. 2011; Associated intra-articular ankle pathologies in patients with chronic lateral ankle instability: arthroscopic findings at the time of lateral ankle reconstruction. Foot Ankle Spec. 4:284–9. doi: 10.1177/1938640011416355. DOI: 10.1177/1938640011416355. PMID: 21926361.

31. Moon JS, Lee K, Lee HS, Lee WC. 2010; Cartilage lesions in anterior bony impingement of the ankle. Arthroscopy. 26:984–9. doi: 10.1016/j.arthro.2009.11.021. DOI: 10.1016/j.arthro.2009.11.021. PMID: 20620798.

32. Strauss JE, Forsberg JA, Lippert FG 3rd. 2007; Chronic lateral ankle instability and associated conditions: a rationale for treatment. Foot Ankle Int. 28:1041–4. doi: 10.3113/FAI.2007.1041. DOI: 10.3113/FAI.2007.1041. PMID: 17923051.

33. O'Neill PJ, Parks BG, Walsh R, Simmons LM, Miller SD. 2007; Excursion and strain of the superficial peroneal nerve during inversion ankle sprain. J Bone Joint Surg Am. 89:979–86. doi: 10.2106/JBJS.F.00440. DOI: 10.2106/JBJS.F.00440. PMID: 17473134.

34. Nitz AJ, Dobner JJ, Kersey D. 1985; Nerve injury and grades II and III ankle sprains. Am J Sports Med. 13:177–82. doi: 10.1177/036354658501300306. DOI: 10.1177/036354658501300306. PMID: 4014532.

35. Snyder RB, Lipscomb AB, Johnston RK. 1981; The relationship of tarsal coalitions to ankle sprains in athletes. Am J Sports Med. 9:313–7. doi: 10.1177/036354658100900505. DOI: 10.1177/036354658100900505. PMID: 6792935.

36. Aynardi M, Pedowitz DI, Raikin SM. 2015; Subtalar instability. Foot Ankle Clin. 20:243–52. doi: 10.1016/j.fcl.2015.02.007. DOI: 10.1016/j.fcl.2015.02.007. PMID: 26043241.

37. Scranton PE Jr, McDermott JE, Rogers JV. 2000; The relationship between chronic ankle instability and variations in mortise anatomy and impingement spurs. Foot Ankle Int. 21:657–64. doi: 10.1177/107110070002100805. DOI: 10.1177/107110070002100805. PMID: 10966363.

38. Cannon LB, Hackney RG. 2000; Anterior tibiotalar impingement associated with chronic ankle instability. J Foot Ankle Surg. 39:383–6. doi: 10.1016/s1067-2516(00)80074-5. DOI: 10.1016/S1067-2516(00)80074-5. PMID: 11131475.

39. Cho BK, Shin YD, Park HW. 2018; Outcome following a modified Broström procedure and arthroscopic debridement of medial gutter osteoarthritis combined with chronic ankle instability. Foot Ankle Int. 39:1473–80. doi: 10.1177/1071100718793395. DOI: 10.1177/1071100718793395. PMID: 30132691.

40. Irwin TA, Anderson RB, Davis WH, Cohen BE. 2010; Effect of ankle arthritis on clinical outcome of lateral ankle ligament reconstruction in cavovarus feet. Foot Ankle Int. 31:941–8. doi: 10.3113/FAI.2010.0941. DOI: 10.3113/FAI.2010.0941. PMID: 21189185.

41. Takao M, Komatsu F, Naito K, Uchio Y, Ochi M. 2006; Reconstruction of lateral ligament with arthroscopic drilling for treatment of early-stage osteoarthritis in unstable ankles. Arthroscopy. 22:1119–25. doi: 10.1016/j.arthro.2006.06.012. DOI: 10.1016/j.arthro.2006.06.012. PMID: 17027411.

42. Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, et al. 2008; Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med. 36:1750–62. doi: 10.1177/0363546508316773. DOI: 10.1177/0363546508316773. PMID: 18753679.

43. van Bergen CJ, Kox LS, Maas M, Sierevelt IN, Kerkhoffs GM, van Dijk CN. 2013; Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up. J Bone Joint Surg Am. 95:519–25. doi: 10.2106/JBJS.L.00675. DOI: 10.2106/JBJS.L.00675. PMID: 23515986.

44. Vega J, Golanó P, Peña F. 2016; Iatrogenic articular cartilage injuries during ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc. 24:1304–10. doi: 10.1007/s00167-014-3237-5. DOI: 10.1007/s00167-014-3237-5. PMID: 25151362.

45. Sammarco VJ. 2001; Complications of lateral ankle ligament reconstruction. Clin Orthop Relat Res. (391):123–32. doi: 10.1097/00003086-200110000-00013. DOI: 10.1097/00003086-200110000-00013. PMID: 11603660.