Ankle sprains are common. They are the most common musculoskeletal injury in athletes and account for about 2 million emergency department visits annually in the United States. Although ankle radiographs are often indicated to rule out fractures of the acutely sprained ankle, the need for additional imaging work-up, such as stress radiographs, to evaluate the severity of ligamentous injury is not clear. One hundred five patients with severe ankle sprains diagnosed by stress radiographs were randomized into three conservative modes of therapy (Schantz wrap, cast brace, cast) and followed prospectively for 7 years. There was no statistically significant difference among treatment groups for mechanical outcome at 1 year (P=0.27) or for functional outcome at 5 years (P=0.39) and 7 years (P=0.27) after injury. We conclude that: (a) there currently is no recommendation for stress radiographs in the setting of the acutely sprained ankle, and (b) a larger multicenter study is needed to confirm these findings.
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Boruta PM, Bishop JO, Braly WG, Tullos HS. Foot Fellows Review. Acute lateral ankle ligament injuries: a literature review. Foot Ankle 1990;11:107–13.
Perlman M, Leveille D, DeLeonibus J, et al. Inversion lateral ankle trauma: differential diagnosis, review of the literature, and prospective study. J Foot Surg 1987;26:95–135.
Brostrom L. Sprained ankles. I. Anatomic lesions in recent sprains. Acta Chir Scand 1964;128:483–95.
Jaskula R, Fischer G, Schedl R. Injuries of the lateral ligaments of the ankle joint: operative treatment and long-term results. Arch Orthop Trauma Surg 1988;107:217–21.
Funder V, Jorgensen JP, Andersen A, Andersen SB, Lindholmer E, Niedermann B, et al. Ruptures of the lateral ligaments of the ankle. Acta Orthop Scand 1982;53:997–1000.
Niedermann B, Andersen A, Andersen SB, Funder V, Jorgensen JP, Lindholmer E, et al. Rupture of the lateral ligaments of the ankle: operation or plaster cast? Acta Orthop Scand 1981;52:579–87.
Moller-Larsen F, Wethelund J, Jurik A, Carvalho A, Lucht U. Comparison of three different treatments for ruptured lateral ankle ligaments. Acta Orthop Scand 1988;59:564–6.
Lindstrand A, Mortensson W. Anterior instability in the ankle joint following acute lateral sprain. Acta Radiol Diagn 1977;18:529–39.
Sauser DD, Nelson RC, Lavine MH, Wu CW. Acute injuries of the lateral ligaments of the ankle: comparison of stress radiography and arthrography. Radiology 1983;148:653–7.
Seligson D, Gassman J, Pope M. Ankle instability: evaluation of the lateral ligaments. Am J Sports Med 1980;8:39–42.
Evans GA, Hardcastle P, Frenyo AD. Acute rupture of the lateral ligaments of the ankle. J Bone Joint Surg Br 1984;66:209–12.
Cass JR, Morrey BF, Yoshihisa K, Chao EYS. Ankle instability: comparison of primary repair and delayed reconstruction after long-term follow-up study. Clin Orthop 1985;198:110–7.
Zwipp H, Hoffman R, Thermann H, Wipperman BW. Rupture of the ankle ligaments. Int Orthop 1991;15:245–9.
Cox JS. Surgical and nonsurgical treatment of acute ankle sprains. Clin Orthop 1985;198:118–26.
Clark BL, Derby AC, Power RI. Injuries of the lateral ligament of the ankle: conservative vs. operative repair. Can J Surg 1965;8:358–63.
Bonnin JG. The hypermobile ankle. Proc R Soc Med 1944;37:282–6.
Drez D, Young J, Waldman D, et al. Nonoperative treatment of double lateral ligament tears of the ankle. Am J Sports Med 1982;10:197–200.
Cass JR, Morrey BF. Ankle instability: current concepts, diagnosis and treatment. Mayo Clin Proc 1984;59:165–70.
Gross AE, MacIntosh DL. Injury to the lateral ligament of the ankle: a clinical study. Can J Surg 1973;16:115–7.
Leonard MH. Injuries of the lateral ligament of the ankle: a clinical and experimental study. J Bone Joint Surg Am 1949;31:373–7.
MacCartee CC. Taping treatment of severe inversion sprains of the ankle. Am J Sports Med 1977;5:246–7.
Linde F, Hvass I, Jurgensen U, Madsen F. Early mobilizing treatment in lateral ankle sprains. Scand J Rehabil Med 1986;18:17–21.
Staples OS. Ruptures of the fibular collateral ligaments of the ankle. J Bone Joint Surg Am 1975;57:101–7.
Ruth CJ. The surgical treatment of injuries of the fibular collateral ligaments of the ankle. J Bone Joint Surg Am 1961;43:229–39.
Brostrom L. Sprained ankles. V. Treatment and prognosis in recent ligament ruptures. Acta Chir Scand 1966;132:537–50.
Karrlson J, Lansinger O. Lateral instability of the ankle joint. Clin Orthop 1992;276:253–61.
Freeman MAR. Treatment of ruptures of the lateral ligaments of the ankle. J Bone Joint Surg Br 1965;47:661–8.
Freeman MAR. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg Br 1965;47:669–77.
Freeman MAR. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 1965;47:678.
Soboroff S, Pappius E, Komaroff A. Benefits, risks and costs of alternative approaches to the evaluation and treatment of severe ankle sprain. Clin Orthop 1984;183:160–8.
Anderson KH, LeCocq JF. Operative treatment of injury to the fibular collateral ligament of the ankle. J Bone Joint Surg Am 1954;36:825–32.
Konradsen L, Holmer P, Sondergaard L. Early mobilizing treatment for grade III ankle ligament injuries. Foot Ankle 1991;12:69–73.
Karrlson J, Bergsten T, Lansinger O, Peterson L. Surgical treatment of chronic lateral instability of the ankle joint. Am J Sports Med 1989;17:268–74.
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Vitellas, K.M., Mueller, C.F., Blau, N.A. et al. The role of stress radiographs for the severe ankle sprain: A 7-year prospective study. Emergency Radiology 2, 339–344 (1995). https://doi.org/10.1007/BF02615897
- Ankle sprain
- Talar tilt
- Anterior drawer
- Stress radiographs