eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Recurrent Ankle Sprains: Follow-up

Author: Joseph R Bozzelle, Jr, MD, Director, Rehabilitation Services, Crowley Rehabilitation Hospital, Doctors Hospital of Opelousas, Southwest Medical Center
Coauthor(s): Stephen Kishner, MD, MHA, Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans; James Monroe Laborde, MD, MS, Clinical Assistant Professor, Department of Orthopedics, Tulane Medical School; Adjunct Assistant Professor, Department of Biomedical Engineering, Tulane University; Adjunct Assistant Professor, Department of Physical Medicine and Rehabilitation, Louisiana State University Medical School; Consulting Staff, Department of Orthopedic Surgery, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Feb 15, 2008

Outcome and Prognosis

If recurrent ankle sprains are treated early and appropriate rehabilitation is initiated, the prognosis is excellent with conservative treatment.36,37,38 The prognosis becomes even more important to consider for those who require surgical correction. Reconstructive procedures can vary significantly in their ability to correct any persistent instability. (See Surgical therapy for a discussion of the percentage ranges of persistent instability following each procedure.)

The Chrisman-Snook procedure seems to have the least incidence of objective instability of the procedures discussed earlier (see Surgical therapy). There are biomechanical data to support the more anatomic reconstructions.31 These procedures tend to restore the ligamentous force patterns more closely to the normal patterns than the tenodesis procedures.

With respect to chronic syndesmotic sprains, long-term outcome studies are few in number. In a study conducted at West Point, all patients who were studied returned to full duty without further problems. One of these patients was surgically treated, and all had full range of motion in the ankle.10

Edwards and DeLee studied 6 cases of patients with frank diastasis.39 In the 4- to 60-month follow-up period, one case of postoperative skin slough healed uneventfully, and one fixation device failed. Four cases had good results, and 2 had fair results in that the patients had residual mild ankle pain and restricted range of motion. Katznelson et al reported on 5 patients with subacute or chronic syndesmotic injury.40 Each was treated with operative stabilization and bone grafting to the tibiofibular joint, which formed a synostosis. By 10 weeks, all the affected ankles had achieved fusion with no complications. One patient developed traumatic osteoporosis that resolved in 6 months. This patient had mild loss of dorsiflexion.

Results are also limited for subtalar instability because this condition is mostly recognized during surgery for chronic lateral ligamentous instability. Most of the available results are intermingled with the results of lateral ankle procedures. Chrisman and Snook had 3 patients with subtalar and ankle instability that were treated by their eponymous procedure.27 One patient had a failed Watson-Jones procedure with persistent instability. The 3 patients with subtalar instability had a 20 º limitation of inversion compared with the opposite, normal side. These patients also had no symptoms of instability at 2-6 years of follow-up.8

Future and Controversies

It is controversial whether arthroscopy is warranted in those patients with known instability who require reconstruction. Some investigators believe that the pathology can be addressed in an open fashion. Those who favor arthroscopy claim that this procedure provides a more detailed view of the ankle joint anatomy and provides ease in the identification of any additional pathology.41,42

Another controversy that exists surrounds the value of stress radiography in the evaluation of a sprained ankle.28 Those who argue against radiography note that stress radiography does not reliably detect a difference between the injured and uninjured sides all of the time. They also note that laxity in the joint does not correlate with the patient's symptoms.

Future ideas for the treatment of chronic ankle instability are promising. One novel idea is to transfer the peroneus tertius tendon so that it can act as a dynamic stabilizer. This procedure is thought to add to the proprioceptive stability of the ankle joint, and it is not technically complex, making it a desirable treatment. Despite the apparent advantages, however, long-term follow-up studies are lacking. A sample search of the literature resulted in 2 studies regarding the peroneus tertius tendon transfer procedure for the purpose of stabilizing the ankle.43,44  Other studies investigated the use of this procedure for correction of drop foot deformities45 and for clawfoot deformities.46

Other procedures for lateral ligamentous reconstruction include using the medial one third of the Achilles tendon, the plantaris tendon, bovine collagen, and carbon-fiber prosthetic ligaments. Follow-up studies are inadequate for these procedures as well.

 


More on Recurrent Ankle Sprains

Overview: Recurrent Ankle Sprains
Workup: Recurrent Ankle Sprains
Treatment: Recurrent Ankle Sprains
Follow-up: Recurrent Ankle Sprains
Multimedia: Recurrent Ankle Sprains
References
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Further Reading

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Keywords

recurrent ankle instability, chronic ankle sprain, chronic ankle instability, subtalar instability, functional ankle instability, chronic medial ligament instability, mechanical ankle instability

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Contributor Information and Disclosures

Author

Joseph R Bozzelle, Jr, MD, Director, Rehabilitation Services, Crowley Rehabilitation Hospital, Doctors Hospital of Opelousas, Southwest Medical Center
Joseph R Bozzelle, Jr, MD is a member of the following medical societies: Louisiana State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Stephen Kishner, MD, MHA, Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans
Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

James Monroe Laborde, MD, MS, Clinical Assistant Professor, Department of Orthopedics, Tulane Medical School; Adjunct Assistant Professor, Department of Biomedical Engineering, Tulane University; Adjunct Assistant Professor, Department of Physical Medicine and Rehabilitation, Louisiana State University Medical School; Consulting Staff, Department of Orthopedic Surgery, Louisiana State University Health Sciences Center
James Monroe Laborde, MD, MS is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Medical Editor

John S Early, MD, Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship Baylor University Medical Center
John S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, and Texas Medical Association
Disclosure: Zimmer Inc Consulting fee Consulting; Smith Nephew Consulting fee Consulting; AO North America Honoraria Speaking and teaching; Osteotech Consulting fee Consulting; Stryker Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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