Lateral ankle ligament injury

Lateral Ankle ligament injuries

Background

Ankle ligament injuries are the commonest sporting injury to the lower limb. Most of us will injure our ligaments at some stage in our lives. Internal (inversion) injuries are the most common mechanism.

What ligaments are damaged?

 

The anterior (anterior talofibular) ligament and the inferior (calcaneofibular) ligaments are the ligaments most frequently damaged. They can be stretched (Grade 1), partially torn Grade 2) or completely torn (Grade 3). Grade 3 injuries are often associated with cartilage damage to the ankle joint or tendon injury.

What is the recovery time?

The majority of ligament healing takes place within the first 2 months of injury. Pain from stretching of the ligaments after this (such as praying) can last for 3-4 months. Patients experiencing pain after 4 months usually have additional mechanical damage to the ankle or inflammatory scar tissue (synovitis). The ankle is at risk of repeated injury in the first 1 year after injury.

Treatment options (based on the best available evidence)

 •If the ankle can bear weight (Grade 1 and 2 injuries), then an ankle brace is recommended.

•If the ankle cannot bear weight and a Grade 3 injury is suspected, then a below knee cast is beneficial, but for no longer than 10 days. An ankle brace is then used. Braces used when returning to sports can also reduce the risk of re-injury.

•Anti-inflammatory medication reduces pain, along with elevation and ice.

•Early weight bearing and physiotherapy are beneficial to reduce pain and to reduce re-injury. Effective physio consists of muscle exercises and balance training (which should be continued at home). A graduated return to sports is advised.

•If painful inflammatory scar tissue is present causing ongoing pain then a steroid injection into the ankle can reduce pain.

• Surgery is not indicted in the first 3 months following a ligament injury. The majority of ligament injuries no not require surgery. If the ankle remains unstable despite effective physio then repair of the ligaments can restore stability and reduce pain (particularly if cartilage or tendon tears are repaired at the same time).