The sporting ankle: an update
The ankle is the most common joint to be injured during sport, accounting for almost 30% of all musculoskeletal injuries. The spectrum of injury includes bony and soft tissue trauma, and ranges from spontaneously resolving simple sprains to significant injuries which can result in permanent loss of function and failure to return to sport. Most injuries follow certain, recognizable patterns with diagnosis often based on clinical examination alone; however, specific injuries can be easily misdiagnosed or overlooked, with potentially devastating sequelae.
The most common pathologies include:
Lateral ligament injuries
Sporting ankle sprains are very common and frequently seen in 15-24-year-old males, but overall incidence is highest in women. The lateral ligament complex is most commonly involved.
Isolated soft tissue syndesmosis injuries are often felt to be small print compared to the much greater frequency of lateral ligament trauma. There is evidence to suggest that the burden from high ankle sprains is greater than previously thought.Pain on anterior inferior tibiofibular ligament squeeze is the most specific examination finding, although less sensitive than extreme dorsiflexion and external rotation
Medial ligament injuries
Medial, or deltoid ligament injuries in the absence of fracture are rare,The deltoid ligament consists of superficial and deep components which are discrete structures, each containing a complex of individual ligaments
Osteochondral lesions of the talus
The term osteochondral lesions (OCL) encompasses the historical diagnosis of osteochondritis dissecans and osteochondral defects of the talus.
The severity of these injuries can be graded using the radiological Berndt and Harty classification
Stage I: subchondral compression
Stage II: partial fragment detached
Stage III: complete fragment detached but undisplaced
Stage IV: displaced fragment.
Bone marrow stimulation (chondroplasty and microfracture)
In this technique, if there is an intact cartilage cap, retrograde drilling procedure can be attempted to try to promote healing of the underlying defect.
procedures have been developed with the aim of restoring hyaline cartilage to the defects.
These grafts can be autologous and harvested from another joint, commonly from the knee or the ankle itself or cadaver allografts. Autologous osteochondral transplantation (AOT), Cadaver osteochondral allograft and Chondrocyte implantation are some more examples.
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