Clinico-anatomical presentation of the ankle sprain - the most common diagnosis in trauma centres

Abstract

Introduction: Ankle sprain injuries are the most common injury sustained during sport activities and in every day live. Three-quarters or more of ankle injuries involve the lateral ligamentous complex, with an equal incidence between males and females. The lateral collateral ligament complex (LCL) consists of the anterior talofibular, calcaneofibular, and posterior talofibular ligaments. The mechanism of injury to the ankle ligaments is inversion and plantar flexion. The ATFL is the weakest of the lateral ankle ligaments. Acute tears are visualized as ligament swelling, discontinuity and hypo echogenicity. Objectives: To present clinic-anatomical aspects of the ankle sprain.Methods: Writing of this report, we studied 7 ankle cadavers and 21 patients with acute ankle instability due to injury to the lateral ligament complex we operated for one year from 09.2015 to 08.2016.Results: The anterior talofibular ligament is the most frequently injured ligament of the ankle and is the most frequently observed injury in the emergency room. This ligament is closely related to the ankle joint capsule. From its origin, it runs anteromedially to the insertion on the talar body immediately anterior to the joint surface occupied by the lateral malleolus. The ligament is virtually horizontal to the ankle in the neutral position but inclines upward in dorsiflexion and downward in plantar flexion.The calcaneofibular ligament originates from the anterior part of the lateral malleolus. In the neutral ankle position, the ligament runs obliquely downwards and backwards to attach to the posterior region of the lateral calcaneal surface. The calcaneofibular ligament becomes horizontal during plantarflexion and vertical in dorsiflexion, remaining tense throughout its entire arc of motion. The posterior talofibular ligament originates from the malleolar fossa, located on the medial surface of the lateral malleolus, coursing almost horizontally to insert in the posterolateral talus.Conclusions: Ankle sprain is the most common injury of the musculo-skeletal system. It is almost 40% of all athletic traumas and more than 12% of all human injuries. Anatomical variations are not of high frequency. The most commonly seen is ATFL consisting of two bands.