Ankle and Foot: Acute Ligamentous Tears of the Ankle

Abstract

Ankle sprains are the most common injury among children and adolescents. The anterior talo-fibular ligament (ATFL) is the first structure to be injured in an inversion sprain. Tears of this ligament can be incomplete, complete, or with avulsion. A capsular lesion is generally present in complete tears and in injuries with avulsed fragments. Effective treatment of these injuries depends on adequate initial assessment. In young patients, avulsions of the chondral or osteochondral fragments are not always revealed by survey radiographs. Therefore, ultrasound examinations should be performed. Management strategies for acute ruptures of the lateral ankle ligaments can be divided into cast immobilization, surgical treatment, and functional treatment. In a number of recent reviews on treatment of acute tears of the lateral ankle ligaments, early mobilization and functional treatment have been advocated. Compared with functional treatment, operative treatment gives a better long-term outcome in terms of residual pain, recurrent sprains, and stability. Nevertheless, there is still controversy as to whether acute ligament ruptures should be treated non-surgically or with primary surgical repair, followed by immobilization using a plaster cast or brace. Consideration of primary surgical repair must be according to the exigencies and expectations of patients and parents, considering that this treatment is one way to ensure a rapid return to a stable and painless ankle in child athletes with acute tears of the ATFL and extensive capsular involvement with or without avulsed fragments.