Chronic lateral ankle instability: a current concepts review

Ziyaad Mayet,Paulo Nf Ferrao,Mohammed A Khademi,Sebastian Km Magobotha,Makgabo J Tladi,Hooman Eshragi,Hossein Ittehadi,Nikiforos Ρ Saragas,Richard Paterson,Alwich Alexander,Mohammed Mehtar,Matthew Workman

doi:10.17159/2309-8309/2021/v20n2a7

Ziyaad Mayet, Paulo Nf Ferrao + Show 10 more

Open Access

https://doi.org/10.17159/2309-8309/2021/v20n2a7

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Abstract

ABSTRACT Injuries to the lateral ankle ligaments are quite common, with a reported incidence of up to 22% of all sports injuries, and 85% of all ankle sprains. Most of these are effectively managed using nonoperative measures in the acute setting. Approximately 20% of patients will, however, develop chronic lateral ankle instability (CLAI). Although the anatomy and biomechanics are well documented, more recently, the concepts of the lateral talofibular calcaneal ligament (LTFCL) and microinstability have been described. For those who develop CLAI, a full assessment is mandatory to not only search for correctable risk factors (malalignment), but also to differentiate between functional and mechanical instability. Associated injuries need to be excluded, such as osteochondral lesions of the talus. Rotational ankle instability is a new concept that needs to be considered. Patients who present with CLAI are initially managed conservatively in the form of functional rehabilitation. This management is especially effective in patients with functional instability. Surgery is generally indicated after failed conservative management in patients with objective mechanical instability. The elite athlete is a relative indication to performing surgery early. The choice of surgical procedure is made on an individualised basis, although open anatomical procedures remain the gold standard. Non-anatomical procedures are no longer recommended. Newer minimally invasive and endoscopic techniques show promise in experienced hands but there is only limited evidence to support its use at present. The use of a suture tape as an augment is reserved for specific indications and should not be used routinely. Level of evidence: Level 5 Keywords: chronic lateral ankle instability, ATFL, CFL, functional rehabilitation, Broström, surgical procedures for lateral ankle ligaments

Highlights

Ligamentous injuries of the ankle, commonly called ankle sprains, are very common
Karlsson et al have been quoted as reporting improvement in 50% of patients with chronic lateral ankle instability (CLAI) using a structured rehabilitation programme, with the emphasis on functional rehabilitation.[7]
This can be achieved with a tendon autograft or allograft, (Figure 8) placed anatomically at the footprints, to replicate the normal anatomy of the native ligaments.[12,30]

Summary

Introduction

Ligamentous injuries of the ankle, commonly called ankle sprains, are very common. There is a reported incidence of up to 22% of all sports injuries. It is imperative that these problems are addressed for a successful outcome.[33] Contraindications to CLAI surgery include neuroarthropathy, spasticity, peripheral vascular disease and a noncompliant patient This group of procedures either repair the native ATFL and CFL or use a tendon graft reconstruction to restore the normal anatomical configuration of the ligaments. This can be achieved with a tendon autograft or allograft, (Figure 8) placed anatomically at the footprints, to replicate the normal anatomy of the native ligaments.[12,30] As a group, anatomical repairs and reconstructions have shown high satisfaction and function rates by Li et al in a 5–10 year follow-up study.[37] In a systematic review, Brambilla et al have shown no evidence of superiority of either autograft and allograft, but noted a lack of good quality studies.[38] into three categories, namely, arthroscopically assisted, allinside and inside-out techniques.

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