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

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

Functional Rehabilitation Matsusaka, AJSM

Treatment Chronic ankle instability Mechanical instability Objective measurement of instability Functional instability Subjective measurement of instability

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

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

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

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

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

Treatment

Treatment Anatomic vs Nonanatomic Evans procedure 1913 Watson-Jones 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 Factors Axial/foot alignment Plantar/dorsiflexion strength Inversion/Eversion strength Gender/sport No significant difference

Prevention Taping Braces 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 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

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

Syndesmotic Ligament Injury

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

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

Thank You!