In extreme anterolateral sprains, Chronic ankle instability
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The aim of this analysis was to equate the prognosis of a combined anterior talofibular (ATFL) and calcaneofibular (CFL) ligament rupture with an individual ATFL rupture in terms of progression to chronic ankle instability and other clinical outcomes.

Clinical studies reporting the prognostic effect of combined ATFL-CFL rupture versus an isolated ATFL rupture in conservatively treated ankle sprains, with a minimum follow-up of 12 months, were eligible for inclusion. Only studies with a reliable diagnostic method for anterolateral ankle ligaments evaluation, namely ultrasonography, magnetic resonance imaging, arthrography or stress tenography, were included.

Results:
--9 papers were selected for inclusion, of which 5 were suitable for quantitative analysis.

--None of them found a statistically significant correlation between ligament injury severity and progression to chronic instability.

--Concerning other clinical outcomes, 3 studies found a statistically significant correlation between a combined ligament injury and a worse clinical prognosis.

--From the quantitative analysis, the relative risk (RR) of chronic ankle instability in a single versus a combined ligament rupture showed no significant difference.

In conclusion, there was no statistically significant connection between a combined ATFL-CFL rupture and chronic ankle instability as compared to an individual ATFL rupture. However, there is reasonable evidence that combined ruptures have a lower clinical outcome score and a lower return to full sports activities. The use of dependable and available diagnostic methods to assess the number of ruptured ligaments could help in the treatment of serious ankle sprains.

Source: https://link.springer.com/article/10.1007/s00167-021-06610-y
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