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Ankle and Foot: Chronic Instability

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Pediatric and Adolescent Sports Traumatology

Abstract

Ankle sprain is a common sports-related injury that predominantly occurs in skeletally mature patients with a lower incidence in children and adolescents. Recurrence of acute twisting episodes may lead to chronic ankle instability, which is distinguished into mechanical and functional. Mechanical ankle instability (MAI) is characterized by an abnormal ankle mobility, assessed clinically using manual stress application via the anterior drawer and the talar tilt tests. Functional ankle instability (FAI) was firstly described as a subjective feeling of the ankle giving way during either physical activity or during common activities of daily living. More than 80 different surgical procedures have been described in literature for managing chronic ankle instability. Anatomic reconstruction should be the primary choice for the surgical treatment of chronic ankle instability in young patient and more widely in athletes. Some studies are available addressing non-anatomic reconstruction in youngers and reporting satisfactory results, even if the need of bony tunnels in a growing epiphysis, alteration in ankle biomechanics and the high frequency of restricted subtalar motion are major drawbacks of non-anatomic reconstruction.

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References

  1. Fernandez WG, Yard EE, Comstock RD (2007) Epidemiology of lower extremity injuries among U.S. high school athletes. Acad Emerg Med 14(7):641–645. Epub 2007 May 18

    Google Scholar 

  2. Maehlum S, Daljord OA (1984) Acute sports injuries in Oslo: a one-year study. Br J Sports Med 18(3):181–185

    Google Scholar 

  3. Bulucu C, Thomas KA, Halvorson TL, Cook SD (1991) Biomechanical evaluation of the anterior drawer test: the contribution of the lateral ankle ligaments. Foot Ankle 11(6):389–393

    Google Scholar 

  4. Stephens MM, Sammarco GJ (1992) The stabilizing role of the lateral ligament complex around the ankle and subtalar joints. Foot Ankle 13(3):130–136

    Article  CAS  PubMed  Google Scholar 

  5. McManama GB Jr (1988) Ankle injuries in the young athlete. Clin Sports Med 7:547–562

    PubMed  Google Scholar 

  6. Larsen E (1988) Tendon transfers for lateral ankle and subtalar joint instability. Acta Orthop Scand 59:168–172

    Article  CAS  PubMed  Google Scholar 

  7. DiGiovanni BF, Fraga CJ, Cohen BE, Shereff MJ (2000) Associated injuries found in chronic lateral ankle instability. Foot Ankle Int 21(10):809–815

    Google Scholar 

  8. Safran MR, Bendetti RS, Bartolozzi AR III, Mandelbaum BR (1999) Lateral ankle sprains: a comprehensive review part 1: etiology, pathoanatomy, istopathogenesis, and diagnosis. Med Sci Sports 31(7):S429–S437

    CAS  Google Scholar 

  9. Chandnani VP, Harper MT, Ficke JR, Gagliardi JA, Rolling L, Christensen KP, Hansen MF (1994) Chronic ankle instability: evaluation with MR arthrography, MR imaging, and stress radiography. Radiology 192(1):189–194

    Google Scholar 

  10. Freeman MA (1965) Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg Br 47:669–677

    CAS  PubMed  Google Scholar 

  11. Hirai D, Docherty CL, Schrader J (2009) Severity of functional and mechanical ankle instability in an active population. Foot Ankle Int 30(11):1071–1077

    Google Scholar 

  12. Karlsson J, Lansinger O (1992) Lateral instability of the ankle joint. Clin Orthop Relat Res (276):253–261

    Google Scholar 

  13. Peters JW, Trevino SG, Renstrom PA (1991) Chronic lateral ankle instability. Foot Ankle 12(3):182–191

    Google Scholar 

  14. Urgüden M, Kızılay F, Sekban H, Samancı N, Ozkaynak S, Ozdemir H (2010) Evaluation of the lateral instability of the ankle by inversion simulation device and assessment of the rehabilitation program. Acta Orthop Traumatol Turc 44(5):365–377

    Article  PubMed  Google Scholar 

  15. Van Dijk CN (2002) Management of the sprained ankle. Br J Sports Med 36(2):83–84

    Google Scholar 

  16. Ajis A, Maffuli N (2006) Conservative management of chronic ankle instability. Foot Ankle Clin 11:531–537

    Article  PubMed  Google Scholar 

  17. Mattacola CG, Dwyer MK (2002) Rehabilitation of the ankle after acute sprain or chronic instability. J Athl Train 27:413–429

    Google Scholar 

  18. Clanton TO, Berson L (1999) Subtalar joint athletic injuries. Foot Ankle Clin 4:729–743

    Google Scholar 

  19. Kato T (1995) The diagnosis and treatment of instability of the subtalar joint. J Bone Joint Surg 77-B:400–406

    Google Scholar 

  20. Letts M, Davidson D, Mukhtar I (2003) Surgical management of chronic lateral ankle instability in adolescents. J Pediatr Orthop 23(3):392–397

    PubMed  Google Scholar 

  21. Bröstrom L (1966) Sprained ankles VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir Scand 132:551–565

    PubMed  Google Scholar 

  22. Rosenbaum D, Becker HP, Wilke HJ et al (1998) Tenodeses destroy the kinematic coupling of the ankle joint complex. A three-dimensional in vitro analysis of joint movement. J Bone Joint Surg Br 80:162–168

    Article  CAS  PubMed  Google Scholar 

  23. Cheng M, Tho KS (2002) Chrisman-Snook ankle ligament reconstruction outcomes: a local experience. Singapore Med J 43(12):605–609

    Google Scholar 

  24. Gould N, Seligson D, Gassman J (1980) Early and late repair of lateral ligament of the ankle. Foot Ankle 1(2):84–89

    Google Scholar 

  25. Karlsson J, Bergsten T, Lansinger O, Peterson L (1988) Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am 70(4):581–588

    Google Scholar 

  26. Li X, Killie H, Guerrero P, Busconi BD (2009) Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Broström repair using suture anchors. Am J Sports Med 37(3):488–494

    Google Scholar 

  27. Coughlin MJ, Schenck RC, Grebing BR, Gehron T (2004) Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft. Foot Ankle Int 25:231–241

    PubMed  Google Scholar 

  28. Pagenstert G, Valderrabano V, Hintermann B (2005) Lateral ankle ligament reconstruction with free plantaris tendon graft. Tech Foot Ankle Surg 4:104–112

    Google Scholar 

  29. Liu SH, Baker CL (1994) Comparison of lateral ankle ligamentous reconstruction procedures. Am J Sports Med 22:313–317

    Article  CAS  PubMed  Google Scholar 

  30. Chrisman OD, Snook GA (1969) Reconstruction of lateral ligament tears of the ankle: an experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure. J. Bone Joint Surg 51-A:904–912

    Google Scholar 

  31. Watson-Jones R (1952) Recurrent forward dislocation of the ankle joint. J Bone Joint Surg 34-B:519

    Google Scholar 

  32. Evans DL (1953) Recurrent instability of the ankle-a method of surgical treatment. Proc R Soc Med 46:343–344

    CAS  PubMed Central  PubMed  Google Scholar 

  33. Marsh JS, Daigneault JP, Polzhofer GK (2006) Treatment of ankle instability in children and adolescents with a modified Chrisman-Snook repair: a clinical and patient-based outcome study. J Pediatr Orthop 26(1):94–99

    Article  PubMed  Google Scholar 

  34. Yang J Jr, Morscher MA, Weiner DS (2010) Modified Chrisman-Snook repair for the treatment of chronic ankle ligamentous instability in children and adolescents. J Child Orthop 4(6):561–570

    Article  PubMed Central  PubMed  Google Scholar 

  35. Barnum MJ, Ehrlich MG, Zaleske DJ (1998) Long-term patient-oriented outcome study of a modified Evans procedure. J Pediatr Orthop 18(6):783–788

    CAS  PubMed  Google Scholar 

  36. Orava S, Jaroma H, Weitz H, Loikkanen T, Suvela M (1983) Radiographic instability of the ankle joint after Evans’ repair. Acta Orthop Scand 54:734–738

    Article  CAS  PubMed  Google Scholar 

  37. Sugimoto K, Takakura Y, Akiyama K, Kamei S, Kitada C, Kumai T (1998) Long-term results of Watson-Jones tenodesis of the ankle. Clinical and radiographic findings after ten to 18 years of follow-up. J Bone Joint Surg Am 80(11):1587–1596

    Google Scholar 

  38. Morelli F, Perugia D, Vadalà A, Serlorenzi P, Ferretti A (2011) Modified Watson-Jones technique for chronic lateral ankle instability in athletes: clinical and radiological mid- to long-term follow-up. Foot Ankle Surg 17(4):247–251

    Article  PubMed  Google Scholar 

  39. Hintermann B, Knupp M, Pagenstert GI (2006) Deltoid ligament injuries: diagnosis and management. Foot Ankle Clin 11(3):625–637

    Article  PubMed  Google Scholar 

  40. Du Vries (1978) Surgery of the foot. St. Louis CV Mosby Company

    Google Scholar 

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Correspondence to Sandro Giannini .

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Giannini, S., Pagliazzi, G., Ruffilli, A., Luciani, D., Pungetti, C., Mosca, M. (2014). Ankle and Foot: Chronic Instability. In: Guzzanti, V. (eds) Pediatric and Adolescent Sports Traumatology. Springer, Milano. https://doi.org/10.1007/978-88-470-5412-7_18

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  • DOI: https://doi.org/10.1007/978-88-470-5412-7_18

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