The unresolved ankle sprain is one of the most common referrals to a specialist orthopaedic foot & ankle surgeon. These injuries occur in sports people as well as workers, and frequently cause prolonged sporting inactivity or time off work. The unresolved ankle sprain can be defined as that injury which does not resolve with appropriate conservative treatment within six weeks. The pathology causing an ankle sprain to be unresolved can involve soft tissue or bony structures. Thorough clinical and radiological assessment is necessary to secure the diagnosis, institute effective surgical treatment and counsel the patient accurately with regards to prognosis for the injury. This paper discusses the differential diagnosis & surgery in order to resolve prolonged disability after the common ankle sprain

Purpose: Pain occasionally develops in the posterior tibial tendon after chronic sprains, whose pathology is not known yet. We inserted an endoscope (tendoscope) into the tendon sheath of the tibialis posterior and treated based on the observation of its pathology. Subjects and methods: Subjects were patients who had complained pain in the posterior tibial tendon after ankle sprain. The interval from the injury to the tendo-scope ranged from one month to one year and 8 months with an average of 9 months. There were 18 patients (11males, 7females). The age ranged from 18 to 33 years with an average of 24 years. For initial treatment, cast fixation, and orthoses were employed in 10 patients. Other 8 patients were left with bandage alone. For these patients, a 2.4mm-diameter endoscope was inserted into the tendon sheath. Results: Synovia proliferation was found in all the cases, and vicula in the tendon sheath disappeared. Synovia proliferation was found in all patients and erosion of the tendon was observed in 8 patients. In other 3 patients, injured sliding floor of the posterior tibial tendon was found. For treatment, synovectomy and smoothing of the sliding floor were performed. All the patients had improvement of pain and returned to sports with the former level. Discussion: It has been known that, in some cases, pain emerges in the posterior tibial tendon after ankle sprain. Its pathology has remained unknown. It is suggested that injuries in the tendon sheath of the tibialis posterior, sliding floor of the tendon, and deltoid ligament associated with the sprain may have caused inflammations, which has developed synovia proliferation. It is thought posterior tibial tendon is often injured after ankle sprain

This study assessed the effect of litigation on the long-term outcome and recovery of ankle inversion injuries. 167 patients from an accident and emergency database were contacted by telephone. Thirty participants were litigating and these candidates were randomly matched with 30 non-litigating patients with respect to mechanism of injury. Each group had 27 patients with ankle sprains because of falls/trips and 3 after road traffic accidents. Radiographs when available of each participant were examined and the degree of soft tissue swelling over the lateral malleolus was assessed. 76.6% of litigants reported incomplete recovery compared to 26.7% of non-litigants. The median period of sleep disturbance, swelling, limping and non-weight-bearing was 1.5 days, 2.0 weeks, 2.0 weeks and 1.0 weeks for the non-litigants. This compares to 3.5 days, 10.0 weeks, 8.0 weeks and 8.0 weeks for the litigants using the same variables (p< 0.0001 in all cases). Where ankle radiographs had been taken swelling was equal in each group (9.0mm over lateral malleolus (30% of litigants incorrectly suggested an ankle x-ray had been taken, when it had not)). The majority of litigants (65%) thought that physiotherapy would not be beneficial in rehabilitating their ankle (35% non-litigants). It appears that litigation has a negative effect on the outcome and recovery of ankle sprains

Purpose of the study: High-energy varus or valgus ankle trauma causes severe injury to the capsule and ligaments. We describe a presentation associating massive tears of the lateral/medial collateral ligaments with a transversal wound of the corresponding malleolus. This wound results from excessive tension on the skin cause by the major varus/valgus. We have defined this injury as an open and severe ankle sprain (OSAS). Material and method: This was a retrospective analysis. We search the databases of three participating centres using the corresponding diagnostic and therapeutic codes from January 2005 to January 2009. The identified files were screened to select patients with OSAS. Results: There were 11 cases of OSAS. Eight involved the lateral side of the ankle and three the medial side. Mean age was 41 years (range 21–45). All patients were victims of a high-energy trauma (five motorcycle accidents) and four patients had fallen from a high point. Associated injuries were tendon section (n=3), section of the deep fibular nerve (n=2), and section of the anterior tibial artery (n=1). Pneumarthrosis was the only visible anomaly on the plain x-rays of seven ankles. Diagnosis was confirmed preoperatively in all cases clinically with varus-valgus stress manoeuvres. Conclusion: OSAS is a rare misleading injury. Confusion with a common wound is possible. The risk is to miss acute instability and thus its treatment. The diagnosis should be proposed for all transversal wounds without contusion over the malleolus with normal x-rays

Ankle sprains are common athletic injuries, with a peak lifetime incidence between the ages of 15 and 19 years, especially in young males. However, an unclear history, an imprecise physical exam, and unhelpful radiographies lead to frequent misdiagnosis of paediatric ankle traumas, and subsequently, inappropriate treatment. Improper management may lead to residual pain, instability, slower return to physical activity, and long-term degenerative changes. The purpose of this study was to evaluate the initial management and treatment of acute paediatric ankle sprains at our center, a tertiary care paediatric hospital. Our hypothesis was that the initial diagnosis is often incorrect, and treatment varies considerably amongst orthopaedic surgeons. We conducted a retrospective study of all cases of ankle sprains and Salter-Harris one (SH1) fractures referred to our orthopaedic surgery service between May and August 2014. Exclusion criteria included ankle fractures other than SH1 types, and cases where treatment was initially undertaken elsewhere before referral to our service. Patients were evaluated on a clinical and radiographic basis. Primary outcome was the difference between initial and final diagnosis. Secondary outcome was variation in immobilisation duration for each diagnosis. The main variables we considered were age, sex, mechanism of trauma, referral delay, patient symptoms, physical exam findings, radiographic findings, type and duration of immobilisation, prescription of any medication, and referral to physical therapy. A total of 3047 patients were reviewed and 31 cases matched our inclusion criteria, comprised of 17 girls and 14 boys, with a mean age of 10.4 years. Patients were seen at a mean of 10.3 days after injury. Initial diagnosis was SH1 fracture in 20 cases, acute ankle sprain in 8 cases, and uncertain in 3 cases. Final diagnosis was SH1 fracture in 11 cases, acute ankle sprain in 13 cases, uncertain in 5 cases, and other in 3 cases. During follow up, 48.5% of cases saw a change in diagnosis. Forty five percent (9/20) of cases initially diagnosed as SH1 fractures proved to be incorrect, with 55.5% (5/9) of these being ultimately diagnosed as acute ankle sprains. Amongst cases initially diagnosed as acute ankle sprains, 37.5% (3/8) received a different final diagnosis. Duration of immobilisation was significantly different between acute ankle sprain and SH1 fracture groups, with an average of 17.3 days and 26.1 days, respectively. Physical therapy was prescribed to 33.3% of acute ankle sprains and 9.1% of SH1 fractures. Initial distinction between acute ankle sprains and SH1 fractures can be difficult in paediatric ankle trauma. Case management and specific treatments vary considerably, as there is neither an evaluation algorithm nor consensus on treatment of these paediatric pathologies. This study reinforces the need to develop a systematic diagnostic and treatment protocol for paediatric ankle sprains

Aims. The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates. Methods. PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model. Results. The screening of titles yielded 206 articles eligible for inclusion in the study. Of these, 173 (84%) articles provided sufficient information to be included in the pooled incidence rates. Incidences of fractures were investigated in 154 studies, and the most common fractures in the whole adult population based on the pooled incidence rates were distal radius fractures (212.0, 95% CI 178.1 to 252.4 per 100,000 person-years), finger fractures (117.1, 95% CI 105.3 to 130.2 per 100,000 person-years), and hip fractures (112.9, 95% CI 82.2 to 154.9 per 100,000 person-years). The most common sprains and dislocations were ankle sprains (429.4, 95% CI 243.0 to 759.0 per 100,000 person-years) and first-time patellar dislocations (32.8, 95% CI 21.6 to 49.7 per 100,000 person-years). The most common injuries were anterior cruciate ligament (17.5, 95% CI 6.0 to 50.2 per 100,000 person-years) and Achilles (13.7, 95% CI 9.6 to 19.5 per 100,000 person-years) ruptures. Conclusion. The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries. Cite this article: Bone Joint Res 2022;11(11):814–825

Ankle sprains have been shown to be the most common sports related injury. Ankle sprain may be classified into low ankle sprain or high ankle sprain. Low ankle sprain is a result of lateral ligament disruption. It accounts for approximately 25% of all sports related injuries. The ankle lateral ligament complex consists of three important structures, namely the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). The ATFL is the weakest and most easily injured of these ligaments. It is often described as a thickening of the anterolateral ankle capsule. The ATFL sits in a vertical alignment when the ankle is plantarflexed and thus is the main stabiliser against an inversion stress. T he CFL is extracapsular and spans both the tibiotalar and talocalcaneal joints. The CFL is vertical when the ankle is dorsiflexed. An isolated injury to the CFL is uncommon. Early diagnosis, functional management and rehabilitation are the keys to preventing chronic ankle instability following a lateral ligament injury. Surgery does not play a major role in the management of acute ligament ruptures. Despite this up to 20% of patients will develop chronic instability and pain with activities of daily living and sport especially on uneven terrain. Anatomic reconstruction for this group of patients is associated with 90% good to excellent results. It is important that surgery is followed by functional rehabilitation. One of the aims of surgery in patients with recurrent instability is to prevent the development of ankle arthritis. It should be noted that the results of surgical reconstruction are less predictable in patients with greater than 10 year history of instability. Careful assessment of the patient with chronic instability is required to exclude other associated conditions such as cavovarus deformity or generalised ligamentous laxity as these conditions would need to be addressed in order to obtain a successful outcome. High ankle sprain is the result of injury to the syndesmotic ligaments. The distal tibiofibular joint is comprised of the tibia and fibula, which are connected by anterior inferior tibiofibular ligament, interosseous ligament and the posterior inferior tibiofibular ligament (superficial and deep components). The mechanism of injury is external rotation and hyperdorsiflexion. High index of suspicion is required as syndesmotic injuries can occur in association of low ankle sprains. The clinical tests used in diagnosing syndesmotic injuries (external rotation, squeeze, fibular translation and cotton) do not have a high predictive value. It is important to exclude a high fibular fracture. Plain radiographs are required. If the radiograph is normal then MRI scan is highly accurate in detecting the syndesmotic disruption. Functional rehabilitation is required in patients with stable injuries. Syndesmotic injuries are often associated with a prolonged recovery time. Accurate reduction and operative stabilisation is associated with the best functional outcome in patients with an unstable syndesmotic injury. Stabilisation has traditionally been with screw fixation. Suture button syndesmosis fixation is an alternative. Early short-term reviews show this alternate technique has improved patient outcomes and faster rehabilitation without the need for implant removal

Acute lateral ankle sprain accounts for 85% of sprains. The lateral sprain is associated with other ligament injuries e.g. medial and syndesmosis sprain. Long-term, approximately 20% of acute lateral sprains develop into chronic lateral ankle instability (CLAI) which includes persistent pain, and recurring ankle sprains. This study evaluated the grade of an ankle ligament injury by ultrasonography (US) and compared the findings to the outcome of patient-reported questionnaires. 48 subjects (18–40 years) diagnosed with an ankle sprain attended a clinical and US examination of ankle ligaments within two weeks after the sprain. Evaluation was done by US of acute lateral ligament injuries (ATFL, CFL), syndesmosis injury (AiTFL), and medial injury (dPT, TCt) only in participants with the positive clinical signs of medial injury. Participants were then mailed a questionnaire (PROMQ) every third month for a year. 29 women and 19 men participated with a mean age at 26.50 years. One-year follow-ups need to be analyzed further for final results. Temporary results include data based on the initial 26 patients: Two clinical signs statistically correlated. Multiple logistic regression analysis confirmed the results. Positive palpated tenderness AiTFL predicted with partial ruptured ATFL and reported pain during active plantar flexion of ankle predicted with normal CFL confirmed by the US. Patients with partial rupture of ATFL presented with tenderness at AiTFL point. Patients presenting with intact CFL reported pain during active plantar flexion. Compared to the US findings, the overall examinations were inconclusive in predicting ATFL, CFL, AiTFL, and medial ligament injuries

The incisura fibularis (IF) provides intrinsic stability to the ankle joint complex by interlocking the distal tibia and fibula. Despite a high frequency of ligamentous ankle injuries, scant attention has been given to the morphology of the IF morphology incisura fibularis in the onset and development of these lesions. Therefore, we systematically reviewed the relation between ligamentous ankle disorders and the morphometrics of the IF. A systematic literature search was conducted on following databases: PubMed, Embase and Web of Science. Search terms consisted of ‘ankle trauma’, ‘ankle injury’, ‘ankle sprain’, ‘ankle fracture’, ‘tibiofibular’, ‘fibular notch’, ‘fibular incisura’, ‘incisura fibularis’, ‘morphometric analysis’, ‘ankle syndesmosis’, ‘syndesmotic stability’. The evaluation instrument developed by Hawker et al. was used to assess the quality of the selected studies. This protocol was performed according to the PRISMA guidelines and is registered on PROSPERO (CRD42021282862). Nineteen studies were included and consisted of prospective cohort (n=1), retrospective comparative (n=10), and observational (n=8) study design. Comparative studies have found certain morphological characteristics in patients with ankle instability. Several studies (n=5) have correlated a shallow IF depth with a higher incidence of ankle injury. A significant difference has also been found concerning the incisura height and angle (n=3): a shorter incisura and more obtuse angle have been noted in patients with ankle sprains. The mean Hawker score was 28 out of 36 (range=24-31). A shallower IF is associated with ligamentous ankle lesions and might be due to a lower osseous resistance against tibiofibular displacement. However, these results should be interpreted in light of moderate methodological quality and should always be correlated with clinical findings. Further prospective studies are needed to further assess the relation between the incisura morphometrics and ligamentous disorders of the ankle joint. Keywords: ankle instability, ankle injury, incisura fibularis, fibular notch, tibiofibular morphometrics, ankle syndesmosis

Ankle sprains are common injuries. Most of them involve the lateral ligament complex. 20–40%% of these injuries will go onto develop symptomatic chronic lateral instability (CLI) and require surgical intervention. The gold standard surgical treatment remains the Brostom-Gould. There are however certain scenarios where this may be unsuitable, such as in hyperlaxity, poor native tissue or revision surgeries. In these situations, a reconstruction with some form of augmentation or grafting is necessary. The anterior half of peroneus longus (AHPL) has gained in popularity as an autograft due to its favourable tendon properties, ease of harvesting, and low reported morbidity. This technique has been adopted by the senior author in these situations. Our primary aim was to assess patient reported outcomes and satisfaction following this surgery. Our secondary objectives were to assess return to sports, donor site morbidity and to report any surgical complications. We performed a retrospective single surgeon study on all patients who underwent CLI reconstruction using the anterior half of peroneus longus between 2014 and 2021. Data was collected prospectively. The Karlsson foot and ankle scoring chart as well as a simple satisfaction table were used to assess outcomes. Minimum follow up was 1 year. 44 patients met the inclusion criteria. 23 women, 21 men. The average age was 37.0 (+−13.5). 24 were very satisfied with the surgery, 10 were satisfied, 6 were fair and 4 were dissatisfied. The average Karlsson score improved from 65/90 (34–77) to 85/90 (range 45–90). The average return to sport was 5 months. There was 1 non-surgical complication recorded. There was no repeat surgery for a complication, or recurrent instability and no donor-site morbidity was reported. The results of our study demonstrates that the CLIR using AHPL is a reliable, predictable and safe

Introduction. Early clinical examination combined with MRI following a high ankle sprain allows accurate diagnosis of syndesmosis instability. However, patients often present late, and for chronic injuries clinical assessment is less reliable. Furthermore, in many centres MRI may be not be readily available. The aims of the current study were to define MRI characteristics associated with syndesmosis instability, and to determine whether MRI patterns differed according to time from injury. Methods. Retrospectively, patients with an unstable ligamentous syndesmosis injury requiring fixation were identified from the logbooks of two fellowship trained foot and ankle surgeons over a five-year period. After exclusion criteria (fibula fracture or absence of an MRI report by a consultant radiologist), 164 patients (mean age 30.7) were available. Associations between MRI characteristics and time to MRI were examined using Pearson's chi-square tests or Fisher's exact tests (significance set at p< 0.05). Results. Overall, 100% of scans detected a syndesmosis injury if performed acutely (within 6 weeks of injury), falling to 83% if performed after 12 weeks (p=0.001). In the acute group, 93.5% of patients had evidence of at least one of either PITFL injury (78.7%), posterior malleolus bone oedema (60.2%), or a posterior malleolus fracture (15.7%). In 20% of patients with a posterior malleolus bone bruise or fracture, the PITFL was reported as normal. The incidence of posterior malleolus bone bruising and fracture did not significantly differ according to time. Conclusion. For unstable ligamentous syndesmosis injuries, MRI becomes less sensitive over time. Importantly, posterior malleolus bone oedema or fracture may be the only evidence of a posterior injury. Failure to recognise instability may lead to inappropriate management of the patient, long term pain and arthritis. We therefore advocate early MRI as it becomes more difficult to ‘grade’ the injury if delayed

Ligament integrity is directly associated with ankle stability. Nearly 40% of ankle sprains result in chronic ankle instability, affecting biomechanics and potentially causing osteoarthritis. Ligament replacement could restore stability and avoid this degenerative pathway, but a greater understanding of ankle ligament behaviour is required. Additionally, autograft or allograft use is limited by donor-site morbidity and inflammatory responses respectively. Decellularised porcine grafts could address this, by removing cellular material to prevent acute immune responses, while preserving mechanical properties. This project will characterise commonly injured ankle ligaments and damage mechanisms, identify ligament reconstruction requirements, and investigate the potential of decellularised porcine grafts as a replacement material. Several porcine tendons were evaluated to identify suitable candidates for decellularisation. The viscoelastic properties of native tissues were assessed using dynamic mechanical analysis (DMA), followed by ramp to ‘sub-rupture’ at 1% strain/s, and further DMA. Multiple samples (n=5) were taken along the graft to assess variation along the tendon. When identifying suitable porcine tendons, a lack of literature on human ankle ligaments was identified. Inconsistencies in measurement methods and properties reported makes comparison between studies difficult. Preliminary testing on porcine tendons suggested there is little variation in viscoelastic properties along the length of tendon. Testing also suggested strain rates of 1%/s sub-rupture was not large enough to affect viscoelastic properties (no changes in storage or loss moduli or tanẟ). Further testing is underway to improve upon low initial sample numbers and confirm these results, with varying strain rates to identify suitable sub-rupture sprain conditions. This work highlights need for new data on human ankle ligaments to address knowledge gaps and identify suitable replacement materials. Future work will generate this data and decellularise porcine tendons of similar dimensions. Collagen damage will be investigated using histology and lightsheet microscopy, and viscoelastic changes through DMA

Background: Injuries to ankle joint consist 12% of visits to emergency departments. In spite of the common occurrence of ankle sprain, syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed. Methods: Among 100 patients with ankle sprain we evaluated the incidence of syndesmosis sprain by MRI of the ankle. Adults who had acute ankle sprain with no fracture and examined on the same day that injury had took place were being included in the survey. Results: Out of 100 patients with ankle injury, four had syndesmosis sprain. Three patients had partial tear of syndesmotic complex and one had complete tear. All injuries occurred in sports except one which had happened in an accident, and two of the patients were athletes. Anterior inferior tibiofibular ligament was the most common ruptured ligament. Conclusions: We reported a four-percent incidence of this injury. Our high rate of this injury emphasized on the fact that all suspicious cases should go under more accurate investigation not to miss this diagnosis

Whilst lateral ankle sprain is often considered a benign injury it represents between 3–5% of all A&E visits in the UK. The mechanical characteristics of ankle ligaments under sprain-like conditions are scarcely reported. The lateral collateral ankle ligaments were dissected from n=6 human cadaveric specimens to produce individual bone-ligament-bone specimens. An Instron Electropuls E10000 was used to uni-axially load the ankle ligaments in tension. The ligaments were first preconditioned between 2 N and a load value corresponding to 3.5% strain for 15 cycles and then strained to failure at a rate of 100%/s. The mean ultimate failure loads and their standard deviations for the anterior talofibular (ATFL), calcaneofibular (CFL) and posterior talofibular (PTFL) ligaments are 351.4±105.6 N, 367.8±76.1 N and 263.6±156.6 N, respectively. Whilst the standard deviation values are high they align with those previously reported for ankle ligament characterisation. The large standard deviations are partly due to the inherent variability of human cadaveric tissue but could also be due to varying previous activity levels of participants or a prior unreported ankle sprain. Although the sample size is relatively small the results were stratified to identify any potential correlations of age, BMI and weight with ultimate load. A strong Pearson correlation (r=0.919) was found between BMI and ultimate load of the CFL but a larger sample size is required to confirm a link. The ligament failure modes were observed and categorised as avulsion or intra-ligamentous failure. The ATFL avulsed from the fibula in five instances and intra-ligamentous failure occurred once. The CFL avulsed from the fibula twice and failed four times through intra-ligamentous failure. Finally, the PTFL avulsed from the fibula once, avulsed from the talus once and failed through intra-ligamentous failure in four instances. The results identify the forces required to severely sprain the lateral collateral ankle ligaments and their failure modes

Following ankle sprain, there can be many causes of disability including ligament injuries, soft tissue or bony impingement, Peroneal tendon tears, osteochondral defects (OCD), synovitis and Osteoarthritis (OA). Aim: To assess the use of Ankle MRI in clinical decision-making in patients with pain and/or chronic instability following ankle sprains. Method: A retrospective case note review was undertaken for all ankle scopes performed and all Ankle MRI ordered by a single surgeon (AOA) over a three-year period (April 2004 – April 2007). Results: During this period 54 Ankle arthroscopies were performed. 24 had pre op MRI scans (16 ordered by AOA and 8 by others who then referred the patient) and 30 had no MRI. 8 case notes were not available. In 43 of the 46 available notes the patients presented with either chronic ankle pain or instability following ankle sprain. 32 had Anterolateral soft tissue impingement on arthroscopy. Of these 24 had MRI scans with only 3 reporting a soft tissue impingement. 13 patients had lateral ligament reconstruction. All 13 of these patients showed signs of instability on examination under anaesthesia (EUA). Of these 9 had MRI scans with 4 reporting a ligamentous injury. Five other patients had MRI scans that showed a lateral ligament injury but had a normal EUA and did not undergo a ligament reconstruction. 10 patients had moderate to severe OA on arthroscopy of the ankle. Of these 4 had MRI scans with 2 reporting OA changes but 2 reported as OCD. Conclusion: Analysing the available data suggests that the indication to perform an arthroscopy is not dependent on the results of the MRI scan but is a clinical one. The decision to reconstruct/repair the lateral ligament complex is a clinical one dependent on patient symptom and the EUA findings

The October 2014 Foot & Ankle Roundup360 looks at: multilayer compression bandaging superior for post-traumatic ankle oedema; compression stockings for ankle fractures; weight bearing ok in Achilles tendon ruptures; MRI findings can predict ankle sprain symptoms; salvage for malreduced ankle fractures; locking fibular plates are more expensive; is fixation better early or late in pilon fractures?; and calcaneal fracture fixation not for subtalar arthropathy

Purpose of the study: Ankle sprains constitute a serious public health problem with nearly 6000 consultations daily in France. The prognosis is generally good if a precise clinical diagnosis can be established and appropriate treatment undertaken. The purpose of this study was to ascertain the pertinence of the initial physical examination which determines the treatment by correlating it with the results of a high-resolution ultrasound examination. Material and methods: This prospective study included 23 patients, mean age 30.7 years, who were followed regularly for three months. A total of 154 ultrasound explorations were performed. The initial treatment for these patients who consulted a hospital emergency room for ankle trauma was established on the basis of the Ottawa criteria. The ankles were examined by a senior physician and an ultrasonographic exploration was performed 3.9 days on average after the first consultation in the emergency room. Standard protocols were used for the physical examination and for the ultrasonography. Results: The initial results confirmed a lesion of the lateral collateral ligament in 91% of cases with an initial tear of the anterior talofibular ligament in half of the cases and a injury to the calcaneofibular ligament in one out of five cases. One quarter of the patients had an isolated lesion. One out of ten presented a lesion of the syndesmosis and one out of three lesions of the fibular tendons. The standard ankle examination performed by the senior physician established correct diagnosis of the precise lesion in 80% of the cases. Discussion: Lesions of the mid food and of the syndesmosis are diagnosed clinically, ultrasonography is not contributive. The stage of the initial lesion was compared with the stage at three months: in 7 out of 10 cases, the anterior talofibular and the calcaneofibular ligaments had healed correctly. Physical examination is essential but ultrasonography provides certain complementary information at a time when the physical examination can be hindered by the pain and potentially the lesser experience of emergency room examinators. Conclusion: In light of the evidence provided by this study, it can be confirmed that the initial diagnosis of ankle sprain established in an emergency room setting can be corrected by a physical examination performed by an experienced clinician. At the present time, it is not possible to demonstrate the specific contribution of ultrasonography for the management of ankle sprains. This would require a prospective study over a longer period and should be designed to demonstrate the relationship between injury of the fibular tendons and ankle stability

Aim:. Ankle sprains are one of the most common sports injuries. Around 10–20 % of the acute ankle sprains may lead to the sequelae of chronic ankle instability. Around 15–35% of the patients have residual pain following successful lateral ligament reconstruction. One of the reasons suggested for the persistent symptoms following lateral ligament reconstruction has been the presence of intra-articular pathology. Methods and materials:. We performed ankle arthroscopy on all patients undergoing the modified Brostrom repair and compared patients with associated intra-articular pathology to those without any intra-articular pathology. Results:. A total of 35 patients underwent the modified Brostrom procedure during the study period. 11/25 patients were found to have associated intra-articular pathology. The average age for both the groups was 33 years. The average follow-up duration was 75 months and 71 months for the intra-articular pathology group and the normal articular groups respectively. The difference in the SAFAS (Sports athlete foot and ankle score) was statistically better in the group without any intra-articular pathology (93.7 compared to 71.6, p-value < 0.05). Conclusions:. The patients who have an associated intra-articular pathology whilst undergoing the stabilisation of lateral ligament instability of the ankle have a slightly poorer outcome compared to those without any intra-articular pathology. Secondly, the SAFAS scoring system seems to overcome the ceiling effect seen in other scoring systems when used for the athletic population

The April 2013 Trauma Roundup. 360 . looks at: ankle sprains; paediatric knee haemarthroses; evidence to support a belief; ‘Moonboot’ saves the day; pamphlets and outcomes; poor gait in pilons; lactate and surgical timing; and marginal results with marginal impaction

Introduction. The ankle cartilage has an important function in walking movements, mainly in sports; for active young people, between 20 and 30 years old, the incidence of osteochondral lesions is more frequent. They are also more frequent in men, affecting around 21,000 patients per year in USA with 6.5% of ankle injuries generating osteochondral lesions. The lesion is a result of ankle sprain and is most frequently found in the medial location, in 53% of cases. The main objective of this work was to develop an experimental and finite element models to study the effect of the ankle osteochondral lesion on the cartilage behavior. Materials and Methods. The right ankle joint was reconstructed from an axial CT scan presenting an osteochondral lesion in the medial position with 8mm diameter in size. An experimental model was developed, to analyze the strains and influence of lesion size and location similar to the patient. The experimental model includes two cartilages constructed by Polyjet™ 3D printing from rubber material (young modulus similar to cartilage) and bone structures from a rigid polymer. The cartilage was instrumented with two rosettes in the medial and lateral regions, near the osteochondral region. The fluid considered was water at room temperature and the experimental test was run at 1mm/s. The Finite element model (FE) includes all the components considered in the experimental apparatus and was assigned the material properties of bone as isotropic and linear elastic materials; and the cartilage the same properties of rubber material. The fluid was simulated as hyper-elastic one with a Mooney-Rivlin behavior, with constants c1=0.07506 and c2=0.00834MPa. The load applied was 680N in three positions, 15º extension, neutral and 10º flexion. Results. The experimental strain measured in the cartilage in the rosettes presents similar behavior in all experiments and repetitions. The maximum value observed near the osteochondral lesion was 3014(±5.6)µε in comparison with the intact condition it was 468 (±1.95)µε. The osteochondral lesion increases the strains around 6.5 times and the synovial liquid reduces the intensity of strain distribution. The numerical model presents a good correlation with the experiments (R2 0.944), but the FE model underestimates the values. Discussion and conclusion. As a first conclusion, the size of the osteochondral lesion is important for the strains developed in cartilage. The size of lesion greater than 10mm is critical for the strains concentration. The synovial fluid present an important aspect in the strains measured, it reduces the strains in the external surface of cartilage and induces an increase in the lower part. This phenomenon should be addressed in more studies to evaluate this effect