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 Surgical treatment (req. in 10-20%)
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 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

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 Braces
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!