Surgical Treatment Paradigms of Ankle Lateral Instability, Osteochondral Defects and Impingement

  • Hélder Pereira
  • Gwendolyn Vuurberg
  • Pietro Spennacchio
  • Jorge Batista
  • Pieter D’Hooghe
  • Kenneth Hunt
  • Niek Van Dijk
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1059)


Ankle sprain is amongst the most frequent musculoskeletal injuries, particularly during sports activities. Chronic ankle instability (CAI) resulting from an ankle sprain might have severe long-lasting consequences on the ankle joint. Despite the fact that most patients will respond favourably to appropriate conservative treatment, around 20% will develop symptomatic CAI with sense of giving away and recurrent sprains leading to functional impairment. “Classical” surgical repair by Brostrom-like surgery in one of its many modifications has achieved good results over the years. Recently, major advances in surgical techniques have enabled arthroscopic repair of ankle instability with favourable outcome while also enabling the treatment of other concomitant lesions: loose bodies, osteochondral defects (OCDs) or ankle impingement. Moreover, when the tissue remnant does not permit a repair technique, anatomic reconstruction by means of using a free graft has been developed. In many cases, OCDs occur as a consequence of CAI. However, traumatic and non-traumatic aetiologies have been described. There is no evidence favouring any surgical treatment over another concerning OCDs. Considering lower cost and limited aggression, microfracture is still the most frequent surgical approach. Herein, the authors describe their algorithm in the treatment of these conditions. Similarly, anterior or posterior impingement might be linked with CAI. These are clinical syndromes based on clinical diagnosis which are currently managed arthroscopically upon failure of conservative treatment.


Ankle impingement syndromes Ankle sprain Chronic lateral ankle instability Osteochondral defects 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Hélder Pereira
    • 1
    • 2
    • 3
    • 4
    • 5
  • Gwendolyn Vuurberg
    • 6
    • 7
    • 8
  • Pietro Spennacchio
    • 9
  • Jorge Batista
    • 10
  • Pieter D’Hooghe
    • 11
  • Kenneth Hunt
    • 12
  • Niek Van Dijk
    • 13
    • 14
    • 15
    • 16
  1. 1.3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine,Avepark, Parque de Ciência e Tecnologia, Zona Industrial da GandraBarco, GuimarãesPortugal
  2. 2.ICVS/3B’s – PT Government Associated LaboratoryBraga/GuimarãesPortugal
  3. 3.Orthopedic Department of Póvoa de Varzim – Vila do Conde Hospital CentrePóvoa de VarzimPortugal
  4. 4.Ripoll y De Prado Sports Clinic: Murcia-Madrid FIFA Medical Centre of ExcellenceMurcia/MadridSpain
  5. 5.International Centre of Sports Traumatology of the AveTaipasPortugal
  6. 6.Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of AmsterdamAmsterdamThe Netherlands
  7. 7.Academic Center for Evidence Based Sports MedicineAmsterdamThe Netherlands
  8. 8.Amsterdam Collaboration for Health and Safety in SportsAmsterdamThe Netherlands
  9. 9.Clinique du Sport, Centre Hospitalier LuxembourgLuxembourgLuxembourg
  10. 10.Clinical Department Club Atletico Boca Juniores and CAJB – Centro Artroscopico, Jorge batista SABuenos AiresArgentina
  11. 11.Aspetar Orthopaedic and Sports Medicine Hospital, Department of Orthopaedic Surgery, Aspire ZoneDohaQatar
  12. 12.Department of Orthopaedic SurgeryUniversity of Colorado School of MedicineAuroraUSA
  13. 13.Ripoll y De Prado Sports Clinic: Murcia-Madrid FIFA Medical Centre of ExcellenceMurcia/MadridSpain
  14. 14.Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of AmsterdamAmsterdamThe Netherlands
  15. 15.Academic Center for Evidence Based Sports MedicineAmsterdamThe Netherlands
  16. 16.Amsterdam Collaboration for Health and Safety in SportsAmsterdamThe Netherlands

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