Ankle Ligament Healing After an Acute Ankle Sprain: An Evidence-Based Approach (Systematic Review) (Clinical Report)
Journal of Athletic Training 2008, Sept-Oct, 43, 5
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Publisher Description
Lateral ankle sprains are among the most common injuries that individuals experience during athletic or recreational activities. Specifically, more than 23 000 ankle sprains are estimated to occur each day in the United States, equating to approximately 1 sprain per 10 000 people daily. (1) Even more concerning than the initial ankle sprain is the large percentage (as many as 70%) (2) of patients who have repetitive ankle sprains and chronic symptoms after the initial injury. The development of repetitive ankle sprains and persistent symptoms after injury has been termed chronic ankle instability (CAI). (3) Chronic ankle instability not only limits physical activity but also can lead to articular degeneration of the ankle joint and an increased risk of osteoarthritis. (4) With the large percentage of patients developing CAI, researchers during the past 40 years have tried to determine why an ankle sprain often continues to affect the patient. When examining the potential causes of CAI, Hubbard et al (5) reported that mechanical laxity was the largest predictor of the development of CAI, explaining 31.3% of the variance with CAI group membership in their study. Additionally, numerous investigators have reported increased ligamentous laxity in individuals with CAI. (5-8) This mechanical laxity may be present because of incomplete healing of the ankle ligaments. The anterior talofibular ligament (ATFL) is reported to be the weakest and the first ligament injured with an ankle sprain. (9) Injury to the ATFL typically is followed by injury to the calcaneofibular ligament (CFL) and the posterior talofibular ligament. (9) Rupture of the ATFL occurs as an isolated injury in 66% of all ruptures of the ankle ligaments and occurs in combination with a rupture of the CFL in another 20%. (9) Because of the damage to these ligaments, an associated increase in the motion present between the talocrural and subtalar joint occurs (hypermobility).