Ankle Lateral Ligament Injury Assessment
Original Editor - Mariam Hashem
Lateral ankle ligament injury is a common MSK condition representing 85% of ankle injuries and has a high recurrence rate (up to 70%). Persisting post-injury symptoms such as swelling, impaired strength, instability (occasional giving way), and impaired balance responses for more than 12 months following the initial injury is defined as '' Chronic Ankle Instability-CAI''. Up to 40% of patients report developing chronic ankle instability.
It is thought that patients who experience a lateral ankle sprain, but do not develop instability, may adopt different neuromuscular control strategies post-injury compared to patients who do develop ankle instability.
Limited dorsiflexion, reduced proprioception, reduced isometric abductor hip strength, postural control deficiencies on SLS  were associated with a higher risk of ankle sprain and instability.
The highest incidence of lateral ankle sprains (LAS) was found for aeroball, basketball, indoor volleyball, field sports and climbing.
A systematic review by Hiller et al reported a larger talar curve, reduced concentric inversion strength, greater sway when standing on stable surfaces with eyes closed, a more inverted ankle position and decreased foot clearance during gait, and prolonged time to stabilization after a jump.
The Ottawa Ankle Rules are used to determine the need for radiography in acute ankle injuries. If these rules are positive, the patient/athlete needs an x-ray to rule out fractures.
The Ottawa Ankle Rules are as follows:
- Tenderness on palpation of :
- Posterior edge/dip of lateral malleolus
- Posterior edge/dip of medial malleolus
- Base of 5th metatarsal
- Navicular bone
- Inability to fully weight-bear for normal 4 steps at the time of injury or on examination
- Mechanism of Injury and WB status. If an athlete was injured during a game, a decision has to be made on return to play based on the MOI and WB status.
- Mechanical and postural contributing Factors
- Two weeks after injury assess against Chronic Ankle Instability using the Cumberland Ankle Instability Tool. A cut off of higher than 11.5 is unlikely to progress to CAI. A lower score is more likely associated with a higher risk of developing CAI
- Assessment of ligamentous laxity:
- Isometric ankle eversion/abduction
Chronic Ankle Instability Checklist
Following LAS, a comprehensive assessment of the factors contributing factors can help predict the prognosis. The following is a set of markers that are associated with CAI:
- ROM Markers:
Weight-bearing ankle Dorsiflexion < 34 degrees on knee to wall test
- Strength Markers:
Isometric hip abduction strength <34% of body weight
- Balance-Stability Markers:
Inability to stand still without getting unsteady/wobbly on the Single-leg balance test for:
- Performance Markers: Unable to complete single leg drop landing test. (from 40 cm) at 2 weeks Unable to complete 10 lateral hops in < 13-15.5 seconds
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- Anterior Drawer Test of Ankle . Available from: https://www.youtube.com/watch?v=dprnjn_OTzo[last access 26/11/2019]
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- Mobility Assessment: Ankle & Calf Flexibility. Athletes, Runners, Squats, High Heels . https://www.youtube.com/watch?v=oQBj3nWSWSE [last access 26/11/2019]
- Single Leg Drop. Ohio State Sports Medicine. https://www.youtube.com/watch?v=2kbv_5bf-e4.[last access 26/11/2019]
- Lateral Hop Test https://www.youtube.com/watch?v=FlebMMhY6Fs.[last access 26/11/2019]