Summary
A prospective randomized clinical study was undertaken to compare bandaging, plaster cast immobilisation and operative treatment for recent tears of the lateral ligament of the ankle. The follow-up period was two years. Subjectively, only the fear of giving-way showed a clear difference in favour of operative repair. Objective evaluation, including stress radiographs, demonstrated no statistical differences between the three methods of treatment. Although bandaging appeared somewhat less satisfactory with respect to the resulting stability of the ankle, the differences were not statistically significant. The lateral ligament in patients over 40 years of age showed a statistically significant tendency to heal less well than that of younger patients.
Severe ankle sprains in patients under 40 years of age should preferably be treated by operation, especially in younger patients and if the person is physically active. Lateral ligament tears in patients over 40 years of age should be treated conservatively and a secondary reconstruction carried out later, if necessary.
Résumé
Une recherche prospective randomisée a été réalisée pour comparer les traitements par bandage adhésif, par immobilisation plâtrée et par opération conjuguée au plâtre dans les lésions récentes du ligament latéral externe de la cheville. Le recul est de deux ans. Sur le plan subjectif la sensation d'instabilité de la cheville était le seul paramètre qui plaidait clairement en faveur de l'opération. L'examen objectif comportant notamment des clichés sous deux incidences en vue d'objectiver des mouvements anormaux de la tibiotarsienne n'a cependant pas fait apparaître de différences statistiques entre les trois modes de traitement. Après traitement par bandage l'instabilité était un peu plus fréquente qu'après les autres traitements mais toutefois sans nette différence statistique. Enfin les entorses des sujets de plus de 40 ans ont guéri nettement moins bien que celles des patients plus jeunes.
Les entorses graves du cou de pied devraient donc être traitées opératoirement chez les sujets physiquement actifs et de moins de 40 ans. Pour les lésions des patients plus âgés on recommandera un traitement conservateur que l'on pourra compléter ultérieurement par une reconstruction, si cela s'avère nécessaire.
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Korkala, O., Rusanen, M., Jokipii, P. et al. A prospective study of the treatment of severe tears of the lateral ligament of the ankle. International Orthopaedics 11, 13–17 (1987). https://doi.org/10.1007/BF00266052
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DOI: https://doi.org/10.1007/BF00266052