Ligament Injuries and Instability

Abstract

Acute ankle ligament injuries, especially in the athletic population, are very common. Chronic lateral ankle ligament instability develops in approximately 10-30% of all patients who have previously sustained an acute ligament injury. Ligament injuries can be divided into grades I-III, depending on how serious the injury is. Non-surgical treatment, including strength, agility and reflex training, using balance boards, is strongly recommended as the first treatment and is considered successful in alleviating symptoms of giving way in more than half of the patients. However, with failed non-surgical treatment, there are several options, both surgical repair and reconstruction. These can be further subdivided into direct repair, non-anatomic reconstruction and anatomic reconstruction. At least 60 different procedures have been described, like the original Broström technique, or more complex procedures, using tendon transfers, i.e. tenodesis. It is emphasised that the anatomic procedures, either direct repair or anatomic reconstruction, are preferred. Even though non-anatomic reconstruction leads to the good restoration of ligament laxity, it abnormally increases the inversion stiffness at the subtalar joint, compared with anatomic procedures, and reduces range of motion, and no reconstruction of this type is biomechanically correct. There is therefore an increased risk of developing osteoarthritis of the ankle with inferior functional outcome in the medium to long term. These procedures should be avoided as the first-line surgical choice, and anatomic repair procedures and anatomic reconstructions should instead be preferred