Abstract
Purpose
Recent literature supports early reconstruction of severe acute lateral ligament injuries in professional athletes, suggesting earlier rehabilitation and reduced recurrent instability incidence. Not previously reported, predicting the time to return to training and play is important to both athlete and club. We evaluate the effectiveness and complications of lateral ligament reconstruction in professional athletes. We aim to estimate the time to return to training and sports in both isolated injuries and patients with additional injuries.
Methods
A consecutive series of 42 athletes underwent modified Broström repair for clinically and radiologically confirmed acute grade III lateral ligament injury. Of 42, 30 had isolated complete rupture of ATFL and CFL. Of 42, 12 had additional injuries (osteochondral lesions, deltoid ligament injuries). All patients received minimum of 2 years post-operative assessment.
Results
The median return to training and sports for isolated injuries was 63 days (49–110) and 77 days (56–127), respectively. However, for concomitant injury results were 86 days (63–152) and 105 days (82–178). This delay was significant (p < 0.001). Despite no difference in pre- and post-op VAS scores between the groups, those with combined injuries had significantly lower FAOS pain and symptoms sub-scores post-operatively (p = 0.027, p < 0.001). Two superficial infections responded to oral antibiotics. No patient developed recurrent instability. All returned to their pre-injury level of professional sports.
Conclusion
Lateral ligament reconstruction is a safe and effective treatment for acute severe ruptures providing a stable ankle and expected return to sports at approximately 10 weeks. Despite return to the same level of competition, club and player should be aware that associated injuries may delay return and symptoms may continue. These results may act as a guide to predict the expected time to return to training and to sport after surgical repair of acute injuries and also the influence of associated injuries in prolonging rehabilitation.
Level of evidence
III.
Similar content being viewed by others
References
Boytim MJ, Fischer DA, Neumann L (1991) Syndesmotic ankle sprains. Am J Sport Med 19:294–298
Brodsky A, O’Malley M, Bohne W, Deland J, Kennedy J (2005) An analysis of outcome measures following the Broström-Gould procedure for chronic lateral ankle instability. Foot Ankle Int 26:816–819
Broström L (1966) Sprained ankles VI: surgical treatment of ‘‘chronic’’ ligament ruptures. Acta Chir Scand 132:551–565
Fong D, Hong Y, Chan L, Yung P, Chan K (2007) A systematic review on ankle injury and ankle sprain in sports. Sports Med 37(1):73–94
Gregusch RV, Ferkel RD (2010) Treatment of the unstable ankle with and osteochondral defect. Am J Sport Med 38(4):782–794
Guillo S, Bauer T, Lee J, Takao M, Kong S, Stone J, Mangone P, Malloy A, Perera A, Pearce C, Michels F, Tourne Y, Ghorbani A, Calder J (2013) Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. Orthop Traumatol Surg Res 99(8):411–419
Hinterman B, Valderrabano V, Boss A et al (2004) Medial ankle instability. An exploratory prospective study of fifty two cases. Am J Sport Med 32:183–190
Kannus P, Renstrom P (1991) Current concept review. Treatment for acute tears of the lateral ligaments of the ankle. J Bone Joint Surg Am 73:305–312
Karlsson J, Bergstern T, Peterson L (1988) Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg 70:581–588
Katcherian D (1994) Soft-tissue injuries of the ankle. In: Lutter LD, Mizel MS, Pfeiffer GB (eds) Orthopaedic knowledge update: foot and ankle. AAOS, Rosemont, pp 241–253
Kerkhoffs GM, Tol J (2012) A twist on the athlete’s ankle twist: some ankles are more equal than others. Br J Sports Med 46(12):835–836
Kerkhoffs GM, Van Dijk CN (2013) Acute lateral ankle ligament ruptures in the athlete: the role of surgery. Foot Ankle Clin 18(2):215–218
Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA (2007) Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev CD000380
Kerkhoffs GM, van den Bekerom M, Elders LA, van Beek PA, Hullegie WA, Bloemers GM, de Heus EM, Loogman MC, Rosenbrand KC, Kuipers T, Hoogstraten JW, Dekker R, Ten Duis HJ, van Dijk CN, van Tulder MW, van der Wees PJ, de Bie RA (2012) Diagnosis, treatment and prevention of ankle sprains: an evidence based clinical guideline. Br J Sports Med 46(12):854–860
Kibler WB (1996) Arthroscopic findings in ankle ligament reconstruction. Clin Sports Med 15:799–804
Lee M, Cha JG, Lee YK et al (2012) The bright rim sign on MRI for anterior talofibular ligament injury with arthroscopic correlation. Am J Roentgenol 198(4):885–890
McCollum GA, van den Bekerom MP, Kerkhoffs GM, Calder JD, van Dijk CN (2013) Syndesmosis and deltoid ligament injuries in the athlete. Knee Surg Sports Traumatol Arthrosc 21(6):1328–1337
McCriskin BJ, Kl Cameron, Orr JD, Watermann BR (2015) Management and prevention of acute and chronic instability in athletic patient populations. World J Orthop 6(2):161–171
Nelson A, Collins C, Yard E, Fields S, Comstock R (2007) Ankle injuries among United States high school sports athletes, 2005–2006. J Athl Train 42(3):381–387
Oae K, Takao M, Uchio T, Ochi M (2010) Evaluation of anterior talofibular ligament injury with stress radiography, ultrasound and MR imaging. Skeletal Radiol 39(1):41–47
Peters J, Trevino S, Renstrom P (1991) Chronic lateral ankle instability. Foot Ankle 12:182–191
Pijnenburg ACM, van Dijk CN, Bossuyt PM, Marti RK (2000) Treatment of ruptures of the lateral ankle ligaments: a meta-analysis. J Bone Joint Surg 82-A(6):761–773
Saxena A, Eakin C (2007) Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sport Med 35(10):1680–1687
van den Bekerom M, Kerkhoffs G, McCollom G, Calder J, van Dijk C (2013) Management of acute lateral ligament injury in the athlete. Knee Surg Sports Traumatol 21(6):1390–1395
van Dijk C, Bossuyt P, Marti R (1996) Medial ankle pain after lateral ligament rupture. J Bone Joint Surg Br 78(4):562–567
van Dijk C, Mol B, Lim L, Marti R, Bossuyt P (1996) Diagnosis of ligament rupture of the ankle joint. Physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma. Acta Orthop Scand 67(6):566–570
Verhagen E, Van der Beek A, Bouter L, Bahr R, Van Mechelen W (2004) A one season prospective cohort study of volleyball injuries. Br J Sports Med 38(4):477–481
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
White, W.J., McCollum, G.A. & Calder, J.D.F. Return to sport following acute lateral ligament repair of the ankle in professional athletes. Knee Surg Sports Traumatol Arthrosc 24, 1124–1129 (2016). https://doi.org/10.1007/s00167-015-3815-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-015-3815-1