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Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study is to propose recommendations for the treatment of patients with chronic lateral ankle instability (CAI) based on expert opinions.

Methods

A questionnaire was sent to 32 orthopaedic surgeons with clinical and scientific experience in the treatment of CAI. The questions were related to preoperative imaging, indications and timing of surgery, technical choices, and the influence of patient-related aspects.

Results

Thirty of the 32 invited surgeons (94%) responded. Consensus was found on several aspects of treatment. Preoperative MRI was routinely recommended. Surgery was considered in patients with functional ankle instability after 3–6 months of non-surgical treatment. Ligament repair is still the treatment of choice in patients with mechanical instability; however, in patients with generalized laxity or poor ligament quality, lateral ligament reconstruction (with grafting) of both the ATFL and CFL should be considered.

Conclusions

Most surgeons request an MRI during the preoperative planning. There is a trend towards earlier surgical treatment (after failure of non-surgical treatment) in patients with mechanical ligament laxity (compared with functional instability) and in high-level athletes. This study proposes an assessment and a treatment algorithm that may be used as a recommendation in the treatment of patients with CAI.

Level of evidence

V.

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Acknowledgements

We thank the following surgeons who collaborated in this questionnaire: Jorge Acevedo, Jorge Batista, Thomas Bauer, James Calder, Dominic Carreira, Woojin Choi, Nuno Corte-real, Mark Glazebrook, Ali Ghorbani, Eric Giza, Stéphane Guillo, Kenneth Hunt, Jon Karlsson, SW Kong, Jin Woo Lee, Frederick Michels, Andy Molloy, Peter Mangone, Kentaro Matsui, Caio Nery, Saturo Ozeki, Chris Pearce, Hélder Pereira, Anthony Perera, Bas Pijnenburg, Fernando Raduan, James Stone, Masato Takao, Yves Tourné, Jordi Vega.

ESSKA-AFAS Ankle Instability Group Contributors

Jorge Batista, Thomas Bauer, James Calder, Woojin Choi, Mark Glazebrook, Ali Ghorbani, Stéphane Guillo, Jon Karlsson, SW Kong, Jin Woo Lee, Frederick Michels, Andy Molloy, Peter Mangone, Kentaro Matsui, Caio Nery, Saturo Ozeki, Chris Pearce, Hélder Pereira, Anthony Perera, Bas Pijnenburg, Fernando Raduan, James Stone, Masato Takao, Yves Tourné.

Author information

Authors and Affiliations

  1. Orthopaedic Department, AZ Groeninge Kortrijk, 8500, Kortrijk, Belgium

    Frederick Michels

  2. International Sports Traumatology Centre of Ave, Taipas Termal, Caldas Taipas, Portugal

    H. Pereira

  3. Fortius Clinic, 17 Fitzhardinge St, London, UK

    J. Calder

  4. Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    G. Matricali

  5. Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    G. Matricali

  6. Institute of Orthopaedic Research and Training, KU Leuven, Leuven, Belgium

    G. Matricali

  7. Queen Elizabeth II Health Sciences Center Halifax Infirmary, Dalhousie University, 1796 Summer Street, Halifax, NS, B3H3A7, Canada

    M. Glazebrook

  8. Clinique du Sport, 2 rue Negrevergne, 33700, Bordeaux-Mérignac, France

    S. Guillo

  9. Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Göthenburg, Sweden

    J. Karlsson

Authors
  1. Frederick Michels
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  2. H. Pereira
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  3. J. Calder
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  6. S. Guillo
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  8. Jorge Acevedo
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  9. Jorge Batista
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  11. James Calder
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  12. Dominic Carreira
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  20. Jon Karlsson
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  21. S. W. Kong
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  22. Jin Woo Lee
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  23. Frederick Michels
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  24. Andy Molloy
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  25. Peter Mangone
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  26. Kentaro Matsui
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  27. Caio Nery
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  28. Saturo Ozeki
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  29. Chris Pearce
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  30. Hélder Pereira
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  31. Anthony Perera
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  32. Bas Pijnenburg
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  33. Fernando Raduan
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  34. James Stone
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  35. Masato Takao
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  36. Yves Tourné
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  37. Jordi Vega
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Consortia

The ESSKA-AFAS Ankle Instability Group

Corresponding author

Correspondence to Frederick Michels.

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Michels, F., Pereira, H., Calder, J. et al. Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert. Knee Surg Sports Traumatol Arthrosc 26, 2095–2102 (2018). https://doi.org/10.1007/s00167-017-4556-0

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  • DOI: https://doi.org/10.1007/s00167-017-4556-0

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