Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Lateral Ankle Ligament Ruptures

SYMPTOMS

The patient refers to a sudden sharp tearing pain around the lateral aspect of the ankle
joint after an acute inversion sprain or, on occasions, of recurrent instability after previous sprains.

AETIOLOGY

The anterior talo-fibular (ATF) and fibulo-calcanear (FC) ligaments are the most commonly damaged structures in uncomplicated inversion-plantar flexion ankle sprain. Most of these ruptures heal well within three months but recurrent instability develops in around 20 per cent of cases.
CLINICAL FINDINGS

After an acute episode there is tenderness on palpation over the lateral ligaments, localised bruising or swelling and/or haemarthrosis/ effusion of the joint if both ligaments rupture. Positive anterior drawer (ATF) and talar tilt (FC) tests are typical for these two ligament ruptures.

INVESTIGATIONS

X-ray is often normal but should be taken to rule out fractures, in particular in growing athletes with open growth plates and in elderly athletes when osteoporosis is suspected. MRI may show localised oedema over the lateral ligaments though is not required for the diagnosis, but rather to rule out associated injuries to other major structures.

TREATMENT

After an acute sprain rest, ice, compression, elevation (RICE) is advocated. Early proprioceptive training and weight-bearing exercises are often recommended. Rehabilitation is usually curative and the athlete can resume sport within two to three weeks, occasionally using a brace or strapping during the first 12 weeks. If there is persistent pain or effusion after three weeks, suspect associated injuries to cartilage or other structures. Reconsider the pathoanatomical diagnosis.

REFERRALS

Refer to physiotherapist for mild symptoms and to orthopaedic surgeon if there is severe pain or effusion persists for more than three weeks.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of non-impact sporting activities using well-fitting shoes. During the convalescence and early return to sport an ankle brace or strapping may be used. Suggest low-impact activities such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor decrease of clinical symptoms and signs. Anterior drawer and talar tilt tests should be negative. However it is important to differentiate joint laxity from joint instability. Thus, these two tests may well reflect increased laxity, while the player does not experience subjective or functional instability. Compare with the non-injured side. There are different functional tests for ankle stability for different kinds of sports.

DIFFERENTIAL DIAGNOSES

Syndesmosis ligament tear (positive syndesmosis test); intra-articular cartilage injuries (pain and effusion); dislocation or longitudinal tear of the peroneus tendons (positive peroneus test); MT V fracture (localised pain on palpation); infection (increased temperature); tumour (X-ray); inflammatory diseases (gout, rheumatoid arthritis, systemic diseases etc).

PROGNOSIS

Usually excellent or good. More than 80 per cent of these injuries fully heal within a few weeks. Of the 20 per cent remaining, some may require surgery, but it is unlikely any will lead to long-term sequelae.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>