Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

Abstract

Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study is to analyze and assess the variability across different rehabilitation protocols for care of lateral ankle ligament repair, reconstruction, and suture tape augmentation surgical patients. Using a web-based search for published rehabilitation protocols after lateral ankle ligament repair, reconstruction, and suture tape augmentation, a total of 26 protocols were found. Inclusion criteria was protocols for post-operative care after an ankle ligament surgery (repair, reconstruction, or suture tape augmentation). Protocols for multi-ligament surgeries and non-operative care were excluded. A scoring rubric was created to analyze different inclusion, exclusion, and timing of protocols such as weightbearing, range of motion (ROM), immobilization with brace, single leg exercises, return to running, and return to sport (RTS). Protocols inclusion of different recommendations was recorded along with the time frame that activities were suggested in each protocol. 26 protocols were analyzed. There was variability across rehab protocols for lateral ankle ligament surgical patients especially in the type of immobilizing brace, time to partial and full weigh bearing, time to plantar flexion, dorsiflexion, eversion and inversion movements of the ankle and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement between protocols. The most consistent aspects of protocols were the post-operative restricted ROM and non-weight bearing status, where 100% of Repair, Internal Brace, and unspecific protocols and 86% of reconstruction protocols all recommended no ROM immediately post operatively and 86% repair and 78% reconstruction recommended no weight bearing immediately after surgery either. 66% of suture tape augmentation protocols allowed full weight bearing immediately post operatively. Suture tape augmentation protocols generally allowed rehabilitation to occur on a quicker timeline with full weight bearing by week 4-6 and full ROM by week 8-10 in the majority of protocols. RTS was especially consistent in repair protocols, but varied more in reconstruction. ROM was highly variable across protocols and did not always match up with supporting literature for early mobilization of the ankle. RTS mostly correlated between protocols and the literature. Weight bearing was consistent between most protocols but requires further research to determine what the best practice is for patient outcomes. Overall, there was a lack of published protocols and enough variability that the need for standardization of rehabilitation protocols was shown.