Ankle Injuries in the Athlete

1. Ankle Injuries in the Athlete Michelle Wolcott, MD Assistant Professor, Department of Orthopaedics Team Physician for the University of Colorado Buffaloes And University of Denver Pioneers

2. Treatment • Chronic ankle sprains • Functional rehabilitation • Role in recovery • May attempt for as long as 6 months • Studies have shown that delayed functional rehab can still be successful

3. Functional Rehabilitation Matsusaka, AJSM

4. Treatment • Chronic ankle instability • Mechanical instability • Objective measurement of instability • Functional instability • Subjective measurement of instability

5. Treatment Chronic Ankle Instability • Surgical treatment (req. in 10-20%) • Nonanatomic • tenodeses • Anatomic • Repair/imbrication of tissues

6. Treatment • Nonanatomic • Evans procedure • Average of ATFL & CFL resistance vectors DeLee & Drez

7. Treatment • Nonanatomic • Watson-Jones procedure • Uses peroneus brevis tendon to recreate ATFL DeLee & Drez

8. Treatment • Nonanatomic • Chrisman-Snook • ½ peroneus brevis tendon used to recreate ATFL and CFL DeLee & Drez

9. Treatment • Anatomic • modified Brostrom (Gould) • Anatomic repair of ATFL, CFL with reinforcement using lateral extensor retinaculum DeLee & Drez

10. Treatment

11. Treatment • Anatomic vs Nonanatomic • Evans procedure 1913 • Karlsson, JBJS - 50% excellent, good results at long term follow-up • Watson-Jones • Barbari, F&A; Van Der Rijt, JBJS – good short-term results, inconsistent long term results

12. Treatment • Anatomic vs. Nonanatomic • Chrisman-Snook • Snook, JBJS; Sammarco, AJSM – 80-90% good or excellent results at 10 yrs • Decreased ROM and sural nerve injury not considered in results • modified Brostrom (Gould) • Karlsson, JBJS; Sjolin, F&A – 86-95% good or excellent results at 10 yrs with equivalent results for acute vs chronic rpr

13. Risk Factors • Axial/foot alignment • Plantar/dorsiflexion strength • Inversion/Eversion strength • Gender/sport • No significant difference

14. Prevention • Taping • Shown to be effective for initial stabilization • Aids in proprioception • Braces • Shown to be effective in athletes with h/o previous sprains

15. Prevention • Proprioceptive training • Functional rehabiliation

16. Syndesmotic Ligament Injury • Partial or complete rupture • Often associated with other injuries • Mechanism of injury • Usually dorsiflexion/ext rotation • Diagnosis • Pain over syndesmosis • Positive squeeze test • Radiographic evaluation

18. Syndesmotic Ligament Injury • Treatment • Partial • No clear consensus • Healing rates highly variable • Related to extent of injury • Rate of return ranges from 2 wks to 6 mos • Complete • Surgical stabilization

19. Syndesmotic Ligament Injury

20. Deltoid Ligament Injury • Rare isolated injury • 3% • Most often partial (ant band) • Complete injuries most always associated with ankle fractures or syndesmotic injury • Concussive injury in inversion ankle sprains

21. Conclusions • Ankle injuries very common in the athletic population • Majority recover with functional rehab despite Grade of injury • Associated injuries largely responsible for chronic pain • Primary vs secondary repair yields equivalent results

22. Thank You!