Ankle Ligament Lesions

  • C. Niek van Dijk
  • Gwendolyn VuurbergEmail author


Ankle ligament lesions are common among footballers. In this chapter lateral and isolated syndesmotic ligament injuries will be highlighted emphasizing acute and chronic sprains. Isolated syndesmotic injury can be classified as stable or instable.


Ankle Lateral ligaments Syndesmosis Acute injury Chronic instability 


  1. 1.
    Ivins D (2006) Acute ankle sprain: an update. Am Fam Physician 74(10):1714–1720PubMedGoogle Scholar
  2. 2.
    Woods C et al (2003) The football association medical research programme: an audit of injuries in professional football: an analysis of ankle sprains. Br J Sports Med 37(3):233–238CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fong DT et al (2009) Understanding acute ankle ligamentous sprain injury in sports. Sports Med Arthrosc Rehabil Ther Technol 1:14CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Dubin JC et al (2011) Lateral and syndesmotic ankle sprain injuries: a narrative literature review. J Chiropr Med 10(3):204–219CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hertel J (2002) Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train 37(4):364–375PubMedPubMedCentralGoogle Scholar
  6. 6.
    Lynch SA, Renstrom PA (1999) Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment. Sports Med 27(1):61–71CrossRefPubMedGoogle Scholar
  7. 7.
    Fuller EA (1999) Center of pressure and its theoretical relationship to foot pathology. J Am Podiatr Med Assoc 89(6):278–291CrossRefPubMedGoogle Scholar
  8. 8.
    Verhagen RA, de Keizer G, van Dijk CN (1995) Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg 114(2):92–96CrossRefPubMedGoogle Scholar
  9. 9.
    Mulligan EP (2011) Evaluation and management of ankle syndesmosis injuries. Phys Ther Sport 12(2):57–69CrossRefPubMedGoogle Scholar
  10. 10.
    Williams GN, Allen EJ (2010) Rehabilitation of syndesmotic (high) ankle sprains. Sports Health 2(6):460–470CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Konradsen L, Holmer P, Sondergaard L (1991) Early mobilizing treatment for grade III ankle ligament injuries. Foot Ankle 12(2):69–73CrossRefPubMedGoogle Scholar
  12. 12.
    Harmon KG (2004) The ankle examination. Prim Care 31(4):1025–1037, xCrossRefPubMedGoogle Scholar
  13. 13.
    van Dijk CN et al (1996) Physical examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg Br 78(6):958–962CrossRefPubMedGoogle Scholar
  14. 14.
    van Dijk CN (2002) Management of the sprained ankle. Br J Sports Med 36(2):83–84CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    van Dijk CN et al (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):566–570CrossRefPubMedGoogle Scholar
  16. 16.
    Ruedi T, Huggler A (1981) [Fresh ligament injuries of the ankle joint]. Helv Chir Acta 47(6):763–772PubMedGoogle Scholar
  17. 17.
    Zinman C et al (1979) Acute rupture of the lateral ligaments of the ankle joint, diagnosis and surgical treatment. Am Surg 45(7):465–470PubMedGoogle Scholar
  18. 18.
    O’Neill PJ, Van Aman SE, Guyton GP (2010) Is MRI adequate to detect lesions in patients with ankle instability? Clin Orthop Relat Res 468(4):1115–1119CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Gerstner Garces JB (2012) Chronic ankle instability. Foot Ankle Clin 17(3):389–398CrossRefPubMedGoogle Scholar
  20. 20.
    Kerkhoffs GM et al (2002) An instrumented, dynamic test for anterior laxity of the ankle joint complex. J Biomech 35(12):1665–1670CrossRefPubMedGoogle Scholar
  21. 21.
    Tourne Y et al (2010) Chronic ankle instability. Which tests to assess the lesions? Which therapeutic options? Orthop Traumatol Surg Res 96(4):433–446CrossRefPubMedGoogle Scholar
  22. 22.
    McCollum GA et al (2013) Syndesmosis and deltoid ligament injuries in the athlete. Knee Surg Sports Traumatol Arthrosc 21(6):1328–1337CrossRefPubMedGoogle Scholar
  23. 23.
    Howard DR et al (2012) Magnetic resonance imaging as a predictor of return to play following syndesmosis (high) ankle sprains in professional football players. Sports Health 4(6):535–543CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Brown KW et al (2004) MRI findings associated with distal tibiofibular syndesmosis injury. AJR Am J Roentgenol 182(1):131–136CrossRefPubMedGoogle Scholar
  25. 25.
    Sman AD, Hiller CE, Refshauge KM (2013) Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med 47(10):620–628CrossRefPubMedGoogle Scholar
  26. 26.
    Inklaar H, van Beek PA (2011) Guideline for diagnosis and treatment of acute inversion trauma of the ankle in athletes. Ned Tijdschr Geneeskd 155(33):A3324PubMedGoogle Scholar
  27. 27.
    Kerkhoffs GM et al (2012) Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med 46(12):854–860CrossRefPubMedGoogle Scholar
  28. 28.
    van den Bekerom MP et al (2012) What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train 47(4):435–443PubMedPubMedCentralGoogle Scholar
  29. 29.
    Petersen W et al (2013) Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg 133(8):1129–1141CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Wexler RK (1998) The injured ankle. Am Fam Physician 57(3):474–480PubMedGoogle Scholar
  31. 31.
    Wolfe MW et al (2001) Management of ankle sprains. Am Fam Physician 63(1):93–104PubMedGoogle Scholar
  32. 32.
    Kerkhoffs GM et al (2002) Different functional treatment strategies for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev 3:CD002938PubMedGoogle Scholar
  33. 33.
    Kerkhoffs GM et al (2001) Immobilisation for acute ankle sprain. A systematic review. Arch Orthop Trauma Surg 121(8):462–471CrossRefPubMedGoogle Scholar
  34. 34.
    Jones MH, Amendola AS (2007) Acute treatment of inversion ankle sprains: immobilization versus functional treatment. Clin Orthop Relat Res 455:169–172CrossRefPubMedGoogle Scholar
  35. 35.
    Pijnenburg AC et al (2003) Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial. J Bone Joint Surg Br 85(4):525–530CrossRefPubMedGoogle Scholar
  36. 36.
    Kaikkonen A, Kannus P, Jarvinen M (1996) Surgery versus functional treatment in ankle ligament tears. A prospective study. Clin Orthop Relat Res 326:194–202CrossRefPubMedGoogle Scholar
  37. 37.
    Wening JV, Raabe S, Jungbluth KH (1991) [Comparative study between conservative and surgical therapy of fibular ligament ruptures of the upper ankle joint]. Zentralbl Chir 116(18):1047–1060PubMedGoogle Scholar
  38. 38.
    Pijnenburg AC et al (2000) Treatment of ruptures of the lateral ankle ligaments: a meta-analysis. J Bone Joint Surg Am 82(6):761–773PubMedGoogle Scholar
  39. 39.
    Schmitz R, Jager E (1992) Benefits and risks of surgical therapy of acute lateral fibular ligament rupture of the upper ankle joint. Results of a retrospective study. Aktuelle Traumatol 22(6):276–280PubMedGoogle Scholar
  40. 40.
    Kerkhoffs GM, Van Dijk CN (2013) Acute lateral ankle ligament ruptures in the athlete: the role of surgery. Foot Ankle Clin 18(2):215–218CrossRefPubMedGoogle Scholar
  41. 41.
    Lassus J et al (2001) Anatomical reconstruction of ruptured lateral ligaments of upper ankle joint. Ann Chir Gynaecol 90(3):213–217PubMedGoogle Scholar
  42. 42.
    Maffulli N, Ferran NA (2008) Management of acute and chronic ankle instability. J Am Acad Orthop Surg 16(10):608–615CrossRefPubMedGoogle Scholar
  43. 43.
    Krips R et al (2002) Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle. Clinical and radiological findings after follow-up for 15 to 30 years. J Bone Joint Surg Br 84(2):232–236CrossRefPubMedGoogle Scholar
  44. 44.
    Krips R et al (2001) Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a multicenter study. Foot Ankle Int 22(5):415–421PubMedGoogle Scholar
  45. 45.
    Muijs SP, Dijkstra PD, Bos CF (2008) Clinical outcome after anatomical reconstruction of the lateral ankle ligaments using the Duquennoy technique in chronic lateral instability of the ankle: a long-term follow-up study. J Bone Joint Surg Br 90(1):50–56CrossRefPubMedGoogle Scholar
  46. 46.
    van den Bekerom MP, Raven EE (2009) Arthrex tightrope distal tibiofibular syndesmotic stabilization. Foot Ankle Int 30(6):577–578, author reply 578CrossRefPubMedGoogle Scholar
  47. 47.
    Hubbard TJ, Wikstrom EA (2010) Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open Access. J Sports Med 1:115–122Google Scholar
  48. 48.
    de Vries JS et al (2011) Interventions for treating chronic ankle instability. Cochrane Database Syst Rev 8:CD004124PubMedGoogle Scholar
  49. 49.
    Parlamas G et al (2013) Treatment of chronic syndesmotic injury: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 21(8):1931–1939CrossRefPubMedGoogle Scholar
  50. 50.
    Taylor DC et al (2007) Aggressive surgical treatment and early return to sports in athletes with grade III syndesmosis sprains. Am J Sports Med 35(11):1833–1838CrossRefPubMedGoogle Scholar
  51. 51.
    Mattacola CG, Dwyer MK (2002) Rehabilitation of the ankle after acute sprain or chronic instability. J Athl Train 37(4):413–429PubMedPubMedCentralGoogle Scholar
  52. 52.
    Safran MR et al (1999) Lateral ankle sprains: a comprehensive review part 2: treatment and rehabilitation with an emphasis on the athlete. Med Sci Sports Exerc 31(7 Suppl):S438–S447CrossRefPubMedGoogle Scholar
  53. 53.
    Konradsen L, Olesen S, Hansen HM (1998) Ankle sensorimotor control and eversion strength after acute ankle inversion injuries. Am J Sports Med 26(1):72–77PubMedGoogle Scholar
  54. 54.
    Takao M et al (2012) Functional treatment after surgical repair for acute lateral ligament disruption of the ankle in athletes. Am J Sports Med 40(2):447–451CrossRefPubMedGoogle Scholar
  55. 55.
    Miller BS et al (2012) Time to return to play after high ankle sprains in collegiate football players: a prediction model. Sports Health 4(6):504–509CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Alonso A, Khoury L, Adams R (1998) Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. J Orthop Sports Phys Ther 27(4):276–284CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryAmsterdam Medical CentreAmsterdamThe Netherlands

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