Ankle Lateral Ligament Injury Assessment

Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem, Kim Jackson, Tarina van der Stockt, Jess Bell and Olajumoke Ogunleye

Introduction

Lateral ankle ligament injruy is a common MSK condition representing 85% of ankle injuries and has a high recurrencce rate. 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 70% of patients report developing chronic ankle instability.

Risk Factors are classified into intrinsic and extinsic factors:

limited dorsiflexion, reduced proprioception, postural control deficiencies on SLS

Additional factors that may contribute to an increased risk are reduced strength, coordination, cardiorespiratory, endurance, limited overall ankle joint ROM and decreased peroneal reaction time

What’s new: An increase in available data made it possible to identify female sex as well as potentially a lower BMI being risk factors for ankle sprains. Additionally, a recommendation is provided which was missing in the original guideline.

The highest incidence of LAS was found for aeroball, basketball, indoor volleyball, field sports and climbing.

Assessment

MOI: checking ability of WB after injury. A decision has to be made on the safety pf the player after injury whether he/she is able to continue the game or not.

Assessment of ankle instability to predict if the injured ankle is likely to undergo chronic instability or not. Using a CAI checklist:

Comlpete CAIT questionnaire

Ottawa rule: determine the need for radiographs in acute ankle injuries. If these tests were met, a referral should be done to request an X-ray.

If the ottawa tests were negative, a comprehensive testing for CAI should be done to prevent long-term impact of LAS.

Ottawa rules:

Staight forward: if positive, refer for medical/radiological Ax

1-Tenderness on plapation of :

A-posterior edge/dip of lateral malleoulus

B-Posterior edge/dip of medial malleoulus

C-Base of 5th metatarsal

D-Navicular

Image?

2-Inability to fully weight bear for normal 4 steps at time of injury or on examination

Subjective Assessment:

Mechanism of Injury

Contributing Factors

Objective Assessment:

Assessment of ligamentous laxity: anterior drawer, talar tilt and ankle syndesmosis.

Swelling

Isometric eversion/abduciton

Outcomes Measures:

The Cumberland ankle instability tool

Laxity tests:

ANterior drawer

talar tilt

Syndesmosis Testing:

Squeeze test

dorsi flexion-external rotation test

Cumberland ankle instability tool (CAIT)- cut off 11.5 > unlikely to progress . less: high likely to progress

Chronic ankle instability checklist:

identifies a failed outcome of rehabilitation following an ATFL injury and increased risk of developing CAI.

ROM markers:

WB ankle DF < 34 degrees

Strength markers:

isometric hip abduction strength <34% of body weight

Balance-stability markers:

Single-leg balance test <10 seconds and on toes < 5 seconds without wobbliness.

SEBT: measures.

Performance markers:

unable to complete dingle leg drop landing