Acute ankle sprain: conservative or surgical approach?

Abstract

Ankle sprains fall into two main categories: acute ankle sprains and chronic ankle instability, which are among the most common recurrent injuries during occupational activities, athletic events, training and army service.Acute ankle sprain is usually managed conservatively and functional rehabilitation failure by conservative treatment leads to development of chronic ankle instability, which most often requires surgical intervention.Enhancing the in-depth knowledge of the ankle anatomy, biomechanics and pathology helps greatly in deciding the management options. Cite this article: Al-Mohrej OA, Al-Kenani NS. Acute ankle sprain: conservative or surgical approach? EFORT Open Rev 2016;1:34-44. DOI: 10.1302/2058-5241.1.000010.

Keywords: acute sprain; aetiology; anatomy; ankle; ankle instability; diagnosis; rehabilitation; surgical techniques.

Fig. 1

The lateral collateral ligaments of the ankle joint. The tibiofibular ligament is also shown.

Fig. 2

MRI of lateral aspect of the ankle. a) ATFL is identified by the yellow arrow; b) PTFL is identified by the yellow arrow.

Fig. 3

MRI of lateral aspect of the ankle, showing a tear of the CFL.

Fig. 4

The medial ligament of the ankle (deltoid ligament).

Fig. 5

MRI of the deltoid ligament.

Fig. 6

Inversion of the ankle is the main mechanism in lateral sprains.

Fig. 7

Lateral (a) and medial (b) views of the ankle showing the regions of Ottawa ankle rules. a) Bone tenderness at the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus; b) Bone tenderness at the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus.

Fig. 8

‘Talar-tilt’ test.

Fig. 9

Anterior ‘drawer’ test.

Fig. 10

Evidence-based algorithm for the diagnosis and treatment of acute ankle injuries.