Severe Ankle Sprain Research Articles

The role of stress radiographs for the severe ankle sprain: A 7-year prospective study

Ankle sprains are common. They are the most common musculoskeletal injury in athletes and account for about 2 million emergency department visits annually in the United States. Although ankle radiographs are often indicated to rule out fractures of the acutely sprained ankle, the need for additional imaging work-up, such as stress radiographs, to evaluate the severity of ligamentous injury is not clear. One hundred five patients with severe ankle sprains diagnosed by stress radiographs were randomized into three conservative modes of therapy (Schantz wrap, cast brace, cast) and followed prospectively for 7 years. There was no statistically significant difference among treatment groups for mechanical outcome at 1 year (P=0.27) or for functional outcome at 5 years (P=0.39) and 7 years (P=0.27) after injury. We conclude that: (a) there currently is no recommendation for stress radiographs in the setting of the acutely sprained ankle, and (b) a larger multicenter study is needed to confirm these findings.

Sensory changes associated with severe ankle sprain

An intact afferent nervous system is important in providing the feedback necessary for effective motor control. Joint injury may influence afferent feedback and, if the lower limb is involved, lead to a decrease in stability. Accordingly, the association between severe ankle sprain and local sensory deficit was examined. Measurements of vibration perception, two point discrimination and balance in one legged standing were made in subjects who had sustained a previous severe unilateral ankle sprain and in subjects with no history of lower limb injury. Comparisons between the two groups showed that subjects with previous severe ankle sprain had sensory deficits in all measured variables between the injured and non-injured sides. Such differences between sides was not apparent in the non-injured group. This study highlights that local sensory deficits are associated with severe ankle sprain.

The Influence of Ankle Sprain Injury on Muscle Activation During Hip Extension

The likely influence of a localised injury in a distal joint on the function of proximal muscles is an important consideration in assessment and treatment of musculoskeletal injuries. However, little experimental evidence in humans exists in this area. Accordingly, a controlled study was carried out, in which the function of muscles at the hip was compared between subjects who had suffered previous severe unilateral ankle sprain and matched control subjects. The pattern of activation of the gluteus maximus, the hamstring muscles and the ipsilateral and contralateral erector spinae muscles was monitored through the use of surface electromyography during hip extension from prone lying. Analyses revealed that the pattern of muscle activation in subjects with previous injury differed markedly from normal control subjects, and that changes appeared to occur on both the uninjured and the injured sides of the body. A significant difference between the two groups was the delay in onset of activation of the gluteus maximus in previously injured subjects. The existence of remote changes in muscle function following injury found in this study emphasise the importance of extending assessment beyond the side and site of injury.

Local sensation changes and altered hip muscle function following severe ankle sprain.

Changes in sensory information have been shown to influence muscle function locally. Some clinicians, however, believe that the influence may be more extensive. To investigate this clinical concept, subjects with severe ankle sprain were assessed for local sensation changes and proximal hip/back muscle function. Of a total of 361 potential subjects whose medical histories were assessed, 20 men (age 18-35 years) who had previously sustained a severe unilateral ankle sprain and 11 matched "control" subjects with no previous lower-limb injury participated in the study. Using this experimental model, tests of vibration sensation in the ankle (indicating sensation changes) as well as surface electromyography of muscle recruitment patterns for hip extension (indicating muscle function proximally) of the biceps femoris, gluteus maximus, and lumbar erector spinae muscles were made on both sides of the unilaterally injured and matched control subjects. Significant decreases in vibration perception and significant delays in gluteus maximus muscle recruitment during hip extension were found in the injured group. The author concludes that both local sensory and proximal muscle function changes are associated with unilateral severe ankle sprain.

Early Ankle Mobilization, Part II: A One-Year Follow-Up of Acute, Lateral Ankle Sprains (A Randomized Clinical Trial)

A 1-year follow-up of military members who received either early ankle mobilization or cast immobilization following a moderate or severe lateral ankle sprain was conducted to determine the long-term effects between these two forms of conservative treatment. Functional job- and sports-related disabilities together with subjective complaints were assessed. A significantly large proportion (44%) of all subjects were symptomatic at follow-up. Those receiving early ankle mobilization had slightly more residual subjective complaints compared with those receiving cast immobilization. There was, however, little effect on functional job- or sports-related disability, the early mobilization group having slightly fewer functional problems. There was no difference in subjective complaints or functional limitations by the degree of injury for moderate or severe lateral ankle sprains.

Early Ankle Mobilization, Part I: The Immediate Effect on Acute, Lateral Ankle Sprains (A Randomized Clinical Trial)

A random clinical trial was performed to determine the immediate effects of early ankle mobilization on active duty military members with moderate and severe lateral ankle sprains. Sixty-four subjects were randomly allocated to one of three treatments: a plaster cast, an air-stirrup (Aircast Inc., Summit, New Jersey), or an elastic wrap. Each intervention lasted 2 weeks followed by 3 weeks of rehabilitation. Subjects who were allowed early mobilization returned to work and running significantly sooner than those placed in plaster casts (p = 0.029). Swelling (p = 0.009) and pain (p < 0.001) decreased while range of motion increased (p = 0.027) in the early mobilization groups. Between the mobilization groups, those in the elastic wrap performed as well as those in the air-stirrup.

Severe Ankle Sprains.

In brief Severe (grade 3) ankle sprains with lateral ligament disruption are common in both athletes and nonathletes. Inadequate treatment leads to chronic ankle instability. Twenty-six patients underwent a 3-week treatment program using an ankle-foot orthosis (AFO), followed by a 4-week rehabilitation program. Of these patients, 96% returned to activity without restriction in about 2 1/2 months. Advantages of the AFO include ease of application, patient comfort and convenience, early ambulation, access for therapy, and rapid return to sports with a stable, asymptomatic ankle.

A Pilot Trial of treatment of Acute Inversion Sprains to the ankle by ankle supports

AbstractA simple study is described, which suggests that the Aircast bracing system may usefully shorten recovery time from severe ankle sprains in military personnel.

Syndesmosis Sprains of the Ankle

A retrospective review of the clinical records and radiographs of 1344 ankle sprains occurring over a 41-month period at the United States Military Academy was performed. The incidence and severity of these sprains did not differ significantly from other studies with the exception of those injuries involving the tibiofibular ligaments. Those patients sustaining incomplete injuries to the ankle syndesmosis had a recovery time of almost twice that of those patients with severe (3rd degree) ankle sprains (55 vs. 28 days). Eight of 13 patients with 10 of 15 incomplete syndesmosis injuries were available for follow-up examination and radiographs at an average time of 20 months postinjury (range of 7-39 months). All patients with this injury had a positive "squeeze test" (compression of the fibula to the tibia at mid-calf) at the time of initial examination. Nine of 10 patients developed ossification of the syndesmosis in follow-up radiographs. None of these patients had developed chronic ankle instability, loss of motion, or arthritic changes of the joint at the time of final followup.

The influence of dorsiflexion in the treatment of severe ankle sprains: an anatomical study.

Cadaver studies were performed to examine the applicability of ankle position to the treatment of ruptured fibulocollateral ligaments. Nonembalmed cadaver specimens were studied with anterior drawer and talar tilt stresses before and after division of the ligaments to simulate the sprained ankle. Dorsiflexion completely reduced the anteriorly subluxed talus and apposed the ends of the anterior talofibular ligament in specimens with divided lateral collateral ligaments. The dorsiflexion angle required to reduce the unstable ankle varied from 5 degrees to 15 degrees. These studies suggest that positioning the ankle in dorsiflexion instead of neutral or plantar flexion may have advantages in promoting a stable ankle if immobilization is chosen for treating a grade III sprain.

A prospective study of the treatment of severe tears of the lateral ligament of the ankle

A prospective randomized clinical study was undertaken to compare bandaging, plaster cast immobilisation and operative treatment for recent tears of the lateral ligament of the ankle. The follow-up period was two years. Subjectively, only the fear of giving-way showed a clear difference in favour of operative repair. Objective evaluation, including stress radiographs, demonstrated no statistical differences between the three methods of treatment. Although bandaging appeared somewhat less satisfactory with respect to the resulting stability of the ankle, the differences were not statistically significant. The lateral ligament in patients over 40 years of age showed a statistically significant tendency to heal less well than that of younger patients. Severe ankle sprains in patients under 40 years of age should preferably be treated by operation, especially in younger patients and if the person is physically active. Lateral ligament tears in patients over 40 years of age should be treated conservatively and a secondary reconstruction carried out later, if necessary.

Benefits, Risks, and Costs of Alternative Approaches to the Evaluation and Treatment of Severe Ankle Sprain

A cost-effectiveness analysis was used to compare five methods of management of severe ankle sprain: (1) wrapping the ankle immediately (i.e., without obtaining further roentgenograms); (2) casting the ankle immediately; (3) obtaining stress films and providing treatment accordingly by wrapping, casting, or surgery; (4) obtaining arthrograms and performing appropriate treatment; and (5) obtaining stress films, followed by arthrograms, in patients with positive stress films and administering appropriate treatment. The probability of ankle stability was high for all five strategies (greater than 97%). However, the expected days of morbidity from different strategies ranged from 36.2 to 73.4 per patient, the probability of premature death ranged from 1.5 to 17.7 per 100,000 patients, and the dollar costs ranged from $318 to $941 per patient. Cost-effectiveness and risk/benefit ratios indicated that the "wrap strategy" and the "stress film strategy" were clearly more cost-effective than the other three strategies.

Lateral ligament injury of the ankle in children. Follow-up results of primary surgical treatment.

Among 40 acutely injured ankles in children, surgery revealed a cartilaginous and/or bony fragment in 19, and an isolated rupture of the anterior talo-fibular ligament without any lesion of the bone or cartilage in another 17. In four ankles there was no ligament lesion. The lesions were surgically repaired. All ankles healed well and were painless and functionally stable at follow-up. In four ankles radiographs showed a small subfibular fragment, in which bony fusion had failed, but even these ankles were stable. Two other ankles gave a slightly positive sign in the clinical anterior drawer test as compared with the contralateral uninjured ankle, but there were no signs of functional instability nor were there any subjective complaints. Our results suggest that severe ankle sprains in children may cause isolated ruptures of the anterior talofibular ligament and frequently osteochondral lesions. We therefore advocate primary suture of ruptured lateral ligaments of the ankle in children.

Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Long-term follow-up.

Experience with forty-nine patients with surgically treated transchondral fractures of the talar dome seen between 1957 and 1977 at our institution has indicated that surgical treatment yields a good long-term result. Long-term results in twenty-five patients with sufficiently long follow-up (average, sixty-five months) were recorded. Ninety-two per cent of the patients had had a history of severe ankle sprain or fracture and many had had chronic symptoms before the definitive diagnosis was made. The surgical treatment consisted of drilling and curettage followed by non-weight-bearing and early range-of-motion exercises. Twenty-two patients had good or excellent results, two had fair results, and one had a poor result. In eleven patients followed for five to eighteen years, no deterioration in functional capacity was noted; however, improvement in the postoperative status was noted for as long as eighteen months. Even when it was performed for a chronic lesion the operation gave a high percentage of good results, and the long-term results did not differ appreciably from the results eighteen months postoperatively. No other reports were found concerning long-term follow-up of this lesion.

An improved technique for the evaluation of ligamentous injury in severe ankle sprains.

An improved technique for the evaluation of ligamentous injury in severe ankle sprains.