Ankle Injuries in the AthleteAnkle Injuries in the Athlete

Michelle Wolcott, MDAssistant Professor, Department of Orthopaedics

Team Physician for the University of Colorado Buffaloes

And University of Denver Pioneers

Michelle Wolcott, MDAssistant Professor, Department of Orthopaedics

Team Physician for the University of Colorado Buffaloes

And University of Denver Pioneers

TreatmentTreatment

• 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

• 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

Functional RehabilitationFunctional Rehabilitation

Matsusaka, AJSMMatsusaka, AJSM

TreatmentTreatment

• Chronic ankle instability

–Mechanical instability

• Objective measurement of instability

–Functional instability

• Subjective measurement of instability

• Chronic ankle instability

–Mechanical instability

• Objective measurement of instability

–Functional instability

• Subjective measurement of instability

TreatmentTreatment

Chronic Ankle Instability

–Surgical treatment (req. in 10-20%)

• Nonanatomic

– tenodeses

• Anatomic

–Repair/imbrication of tissues

Chronic Ankle Instability

–Surgical treatment (req. in 10-20%)

• Nonanatomic

– tenodeses

• Anatomic

–Repair/imbrication of tissues

TreatmentTreatment

• Nonanatomic

–Evans

procedure

• Average of ATFL

& CFL resistance

vectors

• Nonanatomic

–Evans

procedure

• Average of ATFL

& CFL resistance

vectors

DeLee & DrezDeLee & Drez

TreatmentTreatment

• Nonanatomic

–Watson-Jones

procedure

• Uses peroneus

brevis tendon to

recreate ATFL

• Nonanatomic

–Watson-Jones

procedure

• Uses peroneus

brevis tendon to

recreate ATFL

DeLee & DrezDeLee & Drez

TreatmentTreatment

• Nonanatomic

–Chrisman-Snook

• ½ peroneus

brevis tendon

used to recreate

ATFL and CFL

• Nonanatomic

–Chrisman-Snook

• ½ peroneus

brevis tendon

used to recreate

ATFL and CFLDeLee & DrezDeLee & Drez

TreatmentTreatment

• Anatomic

– modified Brostrom

(Gould)

• Anatomic repair of

ATFL, CFL with

reinforcement using

lateral extensor

retinaculum

• Anatomic

– modified Brostrom

(Gould)

• Anatomic repair of

ATFL, CFL with

reinforcement using

lateral extensor

retinaculum

DeLee & DrezDeLee & Drez

Treatment

TreatmentTreatment

• 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

• 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

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

Risk FactorsRisk Factors

• Axial/foot alignment

• Plantar/dorsiflexion strength

• Inversion/Eversion strength

• Gender/sport – No significant difference

• Axial/foot alignment

• Plantar/dorsiflexion strength

• Inversion/Eversion strength

• Gender/sport – No significant difference

PreventionPrevention

• Taping

– Shown to be effective for initial stabilization

– Aids in proprioception

• Braces

– Shown to be effective in athletes with h/o

previous sprains

• Taping

– Shown to be effective for initial stabilization

– Aids in proprioception

• Braces

– Shown to be effective in athletes with h/o

previous sprains

Prevention

• Proprioceptive training

• Functional rehabiliation

Syndesmotic Ligament Injury

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

• 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

http://sportsillustrated.cnn.com/inside_game/magazine/football/nfl/news/2002/11/19/nfl

Syndesmotic Ligament Injury

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

• 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

Syndesmotic Ligament Injury

Deltoid Ligament InjuryDeltoid 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

• 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

ConclusionsConclusions

• 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

• 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

Thank You!Thank You!