Ankle injuries may involve the distal tibiofibular syndesmosis and can be associated with a variable degree of trauma to the soft tissue and osseous structures that play an important role in ankle joint stability. Ankle syndesmotic injury may occur solely as a soft tissue injury or in association with variable ankle fractures. Ankle syndesmotic injury does not necessarily lead to ankle instability; however, the coexistence of deltoid ligament injury critically destabilizes the ankle joint. The prevalence of these injuries may be higher than previously reported. The diagnosis of syndesmotic injury as not always easy because isolated ankle sprains may be missed in the absence of a frank diastasis and syndesmotic instability may be unnoticed in the presence of bimalleolar ankle fractures. Controversies arise at almost every phase of treatment includings : type of fixation(screw size, type of implant), number of cortices required for fixation and of need for hardware removal. Regardless of controversies, the most important goal should be restore and maintain the normal tibiofibular relationship to allow for healing of the ligamentous structures of the syndesmosis.
Animals ; Ankle ; Ankle Injuries ; Ankle Joint ; Ligaments ; Prevalence ; Soft Tissue Injuries ; Sprains and Strains

Ankle sprain is one of the most common musculoskeletal injuries. Although most ankle sprains respond well to conservative measures, chronic instability following an acute sprain has been reported to occur in 20% to 40% of patients. Some individuals are eventually indicated for a lateral ankle ligament reconstruction due to persistent ankle instability. More than 80 surgical procedures have been described to address lateral ankle stability. These range from direct repair of the anterior talofibular ligament (ATFL) and of the calcaneofibular ligament (CFL) to reconstructions based on the use of autograft or allograft tissues. However, the best surgical option remains debatable. The modified Broström procedure is most widely used for direct ligament repair, but not always possible because of the poor ATFL or CFL quality or deficiency of these ligaments, which prevents effective shortening imbrication. Furthermore, the importance of a CFL reconstruction has been emphasized recently. On the other hand, it is difficult to achieve an efficient CFL reconstruction during the Broström procedure. Others have reported that an anatomic reconstruction of injured ligaments restores the normal resistance to anterior translation and inversion without restricting subtalar or ankle motion, and as a result, anatomic reconstructions for lateral ankle instability utilizing an autograft or allograft tendon have gained popularity.
Allografts ; Ankle Injuries ; Ankle* ; Autografts ; Hand ; Humans ; Lateral Ligament, Ankle ; Ligaments* ; Sprains and Strains ; Tendons*

Recently we performed arthrography in 10 cases of ankle injuries and obtained abnormal findings roentgenographically suspected to be ligamentous injury in only 8 cases. In two cases surgical exploration was done. Although two arthrographys is not completely reliable and sufficiently specific to justify the use of this technique in elucidating injuries to the lateral ligament complex, it has value in the diagnosis of diastasis (hidden sprains of the anterior or posterior tibio-fibular ligament), in distinction between old and recent lesions and in diagnosing some sprains of the deltoid and lateral ligaments of the ankle.
Ankle Injuries ; Ankle Joint ; Ankle ; Arthrography ; Collateral Ligaments ; Diagnosis ; Ligaments ; Sprains and Strains

Acute sprain of the ankle requires comprehensive history taking and physical examination in diagnosing the type of severity and deciding on the plan of treatment. Literature supports functional treatment as the treatment of choice for grade I and II injuries. During the acute phase, the goal of treatment focuses on controlling pain and swelling. PRICE (protection, rest, ice, compression, and elevation) is a well-established protocol at this phase. There is some evidence that application of ice and use of nonsteroidal anti-inflammatory drugs improves healing and speeds recovery. Then the functional treatment (motion restoration and strengthening exercises) is administered to progress the rehabilitation appropriately in order to facilitate healing and restore the mechanical strength and proprioception. Early mobilization has been shown to result in more rapid return to work and daily activities than immobilization. Grade III injuries still generate controversy in terms of the best management available, and more studies on early mobilization, cast immobilization, or surgery are needed. Even the Cochrane reviews published to date are not conclusive.
Ankle Injuries* ; Ankle* ; Diagnosis* ; Early Ambulation ; Ice ; Immobilization ; Physical Examination ; Proprioception ; Rehabilitation ; Return to Work ; Sprains and Strains

Inversion injury of the lateral ankle ligaments is very common. Few studies, however, have focused on avulsion fracture of the lateral ankle ligaments. A fracture producing a small fragment usually avulsed from lateral malleolus and may be easily misdiagnosed as a sprain because the fragment is superimposed on the lateral malleolus and goes undetected on early radiographs, especially in skeletally immature patients. We present a case of isolated avulsion fracture of the talar attachment of the anterior talofibular ligament in 13-year-old male patient. Diagnosis was confirmed by computed tomography and avulsed fragment was fixed to original talar footprint with suture anchors. A high level of suspicion must be maintained to obtain an accurate diagnosis of avulsion fracture in inversion ankle injury because of the high incidence in children and to prevent recurrent instability.
Adolescent ; Animals ; Ankle ; Ankle Injuries ; Child ; Humans ; Incidence ; Ligaments ; Male ; Sprains and Strains ; Suture Anchors

BACKGROUND: The stimulation and selection of an effective acupoint is important for producing effective analgesia in electraoacupuncture. This study examined the effect of electroacupuncture to different acupoints and investigated the effective acupoint for ankle-sprained pain in rats. METHODS: A Sprain was produced by manually overextending the lateral ligament of the right ankle in rats. Electrical stimulation was delivered individually to five acupoints: bilateral Yangno (SI6s), contralateral Zusanli (ST36), Hapko (LI4) and Sanyinjiao (SP6). The level of pain evoked by ankle sprain was measured by the stepping force of the sprained paw during walking at pre-sprain and 24 hrs after the sprain. The effect of electroacupuncture was evaluated by the % full recovery of the stepping force at 1, 2, 4 hr after terminating electroacupuncture. RESULTS: Electrical stimulation to SI6 and ST36 among the five acupoints produced a significant increase in the % full recovery of the stepping force of the ankle-sprained paw during walking. CONCLUSIONS: The effective acupoints for electroacupuncture on ankle-sprained pain in rats is SI6 and ST36. These points are relatively specific to ankle-sprain. It is important to select the appropriate acupoint for effective electroacupuncture-induced analgesia.
Acupuncture Points* ; Analgesia ; Animals ; Ankle ; Ankle Injuries ; Collateral Ligaments ; Electric Stimulation ; Electroacupuncture* ; Rats* ; Sprains and Strains ; Walking

BACKGROUND: Simultaneous acupuncture to two or more acupoints has been used to improve acupuncture-induced effects in clinical practice. However, there is little evidence supporting the effects of simultaneous electroacupuncture (EA). This study examined whether simultaneous EA with 2 and 2 Hz or 2 and 100 Hz can produce synergic effects on ankle-sprained pain in rats. METHODS: Ankle sprain pain was induced by manually overextending the lateral ligament of the right ankle in rats. Electrical stimulation with 2 Hz was delivered to the Yangno acupoint (SI6) and with 2 or 100 Hz to the Zusanli (ST36), either individually or simultaneously. The level of pain evoked by the ankle sprain was measured by the stepping force of the sprained paw during walking. The analgesic effects of simultaneous EA was evaluated by the percentage recovery of the stepping force at 1, 2 and 4hr after EA and compared to that of individual EA. RESULTS: Individual EA significantly increased the stepping force of the ankle-sprained paw during walking, but there is no difference in the effect between electrical stimulation with 2 and 100 Hz EA. Simultaneous EA with 2 and 2 Hz or 2 and 100 Hz showed no significant improvement of the stepping force compared to individual EA. CONCLUSIONS: Individual EA with 2 and 100 Hz produced comparable analgesic effects. Simultaneous EA applied to the SI6 and ST36 acupoints produced no synergic interaction, therefore has no beneficial effect for ankle-sprained pain compared to individual EA.
Acupuncture ; Acupuncture Points ; Animals ; Ankle Injuries* ; Ankle* ; Collateral Ligaments ; Electric Stimulation ; Electroacupuncture* ; Rats* ; Sprains and Strains ; Walking

Ankle sprains are orthopedic clinical common disease, accounting for joint ligament sprain of the first place. If treatment is not timely or appropriate, the joint pain and instability maybe develop, and even bone arthritis maybe develop. The mechanism of injury of ankle joint, anatomical basis has been fully study at present, and the diagnostic problem is very clear. Along with the development of science and technology, biological modeling and three-dimensional finite element, three-dimensional motion capture system,digital technology study, electromyographic signal study were used for the basic research of sprain of ankle. Biomechanical and kinematic study of ankle sprain has received adequate attention, combined with the mechanism research of ankle sprain,and to explore the the biomechanics and kinematics research progress of the sprain of ankle joint.
Ankle Injuries ; physiopathology ; Ankle Joint ; physiopathology ; Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Sprains and Strains ; physiopathology

Acute lateral ankle sprain, which is the most common musculoskeletal injury, can be treated effectively with appropriate evidence-based initial care using PRICE (protection, rest, ice, compression, and elevation) and functional rehabilitation. Many systemic reviews reporting a high-level of evidence supporting the clinical usefulness and necessity of primary surgical repair for acute lateral ankle sprain have been insufficient. Regardless of the severity of ligament complex injuries, the surgical treatment for acute lateral ankle sprain without concomitant pathologies is not recommended and should be considered only in young professional athletes with complete ligament rupture (grade III) and severe instability.
Ankle Injuries* ; Ankle* ; Athletes ; Humans ; Ice ; Ligaments ; Pathology ; Rehabilitation ; Rupture ; Sprains and Strains

OBJECTIVE: The purpose of this investigation was to document the isokinetic performance deficiencies of the invertor and evertor muscles of chronically sprained ankles. METHOD: Eversion/Inversion testing was performed by a Cybex 6000 isokinetic dynamometer at the speeds of 60degrees/sec and 120degrees/sec on 17 subjects who had unilateral chronic ankle sprain. Values were compared between the involved and uninvolved sides. RESULTS: The inversion peak torque deficits between the involved and uninvolved extremities were significantly greater than eversion deficits at 60degrees/sec and 120degrees/sec. Evertor/Invertor peak torque ratios of involved sides at 60degrees/sec were significantly greater than uninvolved sides. CONCLUSION: We conclude that chronic ankle sprains associate an ankle invertor weakness rather than an evertor weakness. Ankle invertor weakness might be resulted from a disuse atrophy and painful ankle inversion. Further prospective study is needed to determine the relationship between the invertor weakness and the chronic ankle sprain.
Ankle Injuries* ; Ankle* ; Extremities ; Humans ; Muscles ; Muscular Disorders, Atrophic ; Sprains and Strains ; Torque