Chronic lateral ankle instability(CLAI)

 


Lateral ankle sprain

Common injury mechanism

Excessive internal rotation & Inversion 

    of hindfoot 


ATFL (Anterior talo fibular ligament)

Most frequently injured

CFL (Calcaneofibular ligament)

Involved in 50~70% of cases

PTFL (Posterior talofibular ligament)

< 10% 


ATFL & CFL

Joined by arciform fibers

Single functional structure 

Work together to stabilize ankle and subtalar joint 


Chronic Lateral Instability - Diagnosis 

Functional instability

Subjective feeling of ankle instability

Recurrent ankle sprain

Mechanical instability



Symptom

Ankle instability

Recurrent sprain → Repeated episodes of giving way

Chronic persistent anterolateral pain





Chronic Lateral Instability - Diagnosis 

Clinical examination

Anterior drawer

Ankle plantarflexion 20 degrees

Foot is pulled forward


Positive result

“Suction sign”

As synovium is sucked into joint

Talus is drawn anteriorly more than uninjured side

Chronic Lateral Instability - Diagnosis 

Stress radiographs

Objective documentation of mechanical instability


Anterior drawer

≥ 10 mm

> 3 mm than uninjured side 

Talar tilt

≥ 9 degrees

> 3 degrees than uninjured side 






Chronic Lateral Instability - Diagnosis 

MRI

Pathognomonic sign of ligament injury

Ligament swelling

Discontinuity

Wavy pattern

Non-visualization

Associated lesions

Bone, tendon, chondral, impingement … 


★ Torn ligament  ≠  Unstable ankle

Clinical exam with history taking  is more important !

Chronic Lateral Instability - Surgical treatment 

Refractory to a well-structured program of functional and prophylactic rehab

Anatomic procedures

Reproduce normal anatomy & biomechanics

Anatomic repair OR reconstruction 

Depending on local tissue and ligament status


Broström  (1966)

Suture of torn ligament ends

Mid-substance imbrication


Gould et al. (1980)

Extensor retinaculum augmentation

Chronic Lateral Instability - Surgical treatment 

Arthroscopy

Intra-articular conditions

Impingement

Chondral lesion

Loose bodies and osteophytes


Arthroscopic Broström-Gould procedure

Technically demanding

Possible advantages

Less peri-operative pain

Lower complication rate

Higher AOFAS score 


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