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Surgery for Athletes with Chronic Ankle Sprains: Two Methods Compete

About half of all ankle sprains happen during sports. Most sprains get better without surgery. But in 20 percent of cases, one sprain leads to another. When this happens, surgery is needed.

There are a number of surgical techniques to restore ankle stability. These can be divided into two groups. One is called anatomic reconstruction. With this method, surgeons use the original ankle ligaments to repair the ankle. In the other method, called tenodesis, surgeons reconstruct the ankle ligament using tissue from elsewhere in the body, such as the lower leg.

Some studies suggest that anatomic reconstruction has better results. However, these studies have been done on patients with varied activity levels. Obviously, the amount of activity or stress placed on the ankle after surgery affects the results. These authors zeroed in on athletes, to see which surgery held up better under heavy functional demands.

Forty-one athletes had anatomic reconstruction. Thirty-six had tenodesis. All of the patients had tried other kinds of treatment for at least six months before surgery. After surgery, patients wore casts for six weeks. Then they started exercises to improve motion in the joint.

Patients were followed-up about five years after surgery. Compared to patients who had anatomic reconstruction, patients who had tenodesis were more likely to be less active because of the operated ankle. Tenodesis patients had less movement bending their foot upward, and push-off power than the other group. They also showed more looseness in the joint and degenerative changes. Taken together, these problems may lead to more injury and shorten the athlete's career.

Fifty-eight percent of patients in the tenodesis group had good or excellent results from surgery. In contrast, 88 percent of patients who had anatomic reconstruction had good or excellent results. The authors think anatomic reconstruction is the best choice for athletes with chronic ankle sprains. This method has a better chance of restoring normal movement and stability to the ankle so the athlete can safely return to sport.

Rover Krips, MD, et al. Sports Activity Level after Surgical Treatment for Chronic Anterolateral Ankle Instability: A Multicenter Study. In The American Journal of Sports Medicine. January/February 2002. Vol. 30. No. 1. Pp. 13-19.

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