CC BY-NC-ND 4.0 · Avicenna J Med 2016; 06(04): 103-108
DOI: 10.4103/2231-0770.191446

Chronic ankle instability: Current perspectives

Omar A Al-Mohrej
Department of Clinical Affairs, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Nader S Al-Kenani
Department of Clinical Affairs, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
› Institutsangaben
Financial support and sponsorship Nil.


Ankle sprain is reported to be among the most common recurrent injuries. About 20% of acute ankle sprain patients develop chronic ankle instability. The failure of functional rehabilitation after acute ankle sprain leads to the development of chronic ankle instability. Differentiation between functional and anatomical ankle instability is very essential to guide the proper treatment. Stability testing by varus stress test and anterior drawer test should be carried out. Subtalar instability is an important pathology that is commonly by passed during the assessment of chronic ankle instability. Unlike acute ankle sprain, chronic ankle instability might require surgical intervention. The surgical and conservative management options can be very much developed by in-depth knowledge of the ankle anatomy, biomechanics, and pathology. Anatomical repair, augmentation by tendon, or both are the basic methods of surgical intervention. Arthroscopy is becoming more popular in the management of chronic ankle instability.


Artikel online veröffentlicht:
09. August 2021

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  • References

  • 1 Al-Mohrej OA, Al-Kenani NS. Acute ankle sprain: Conservative or surgical approach? EFORT Open Rev 2016;1:28-38.
  • 2 Bridgman SA, Clement D, Downing A, Walley G, Phair I, Maffulli N. Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains. Emerg Med J 2003;20:508-10.
  • 3 van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med 2008;121:324-31.e6.
  • 4 Snyder AR, Parsons JT, Valovich McLeod TC, Curtis Bay R, Michener LA, Sauers EL. Using disablement models and clinical outcomes assessment to enable evidence-based athletic training practice, part I: Disablement models. J Athl Train 2008;43:428-36.
  • 5 Hølmer P, Søndergaard L, Konradsen L, Nielsen PT, Jørgensen LN. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int 1994;15:72-4.
  • 6 Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am 2010;92:2279-84.
  • 7 Soboroff SH, Pappius EM, Komaroff AL. Benefits, risks, and costs of alternative approaches to the evaluation and treatment of severe ankle sprain. Clin Orthop Relat Res 1984;183:160-8.
  • 8 Waterman BR, Belmont PJ Jr., Cameron KL, Deberardino TM, Owens BD. Epidemiology of ankle sprain at the United States Military Academy. Am J Sports Med 2010;38:797-803.
  • 9 Golanó P, Vega J, de Leeuw PA, Malagelada F, Manzanares MC, Götzens V, et al. Anatomy of the ankle ligaments: A pictorial essay. Knee Surg Sports Traumatol Arthrosc 2010;18:557-69.
  • 10 Ajis A, Maffulli N. Conservative management of chronic ankle instability. Foot Ankle Clin 2006;11:531-7.
  • 11 Rodriguez-Merchan EC. Chronic ankle instability: Diagnosis and treatment. Arch Orthop Trauma Surg 2012;132:211-9.
  • 12 Maffulli N, Ferran NA. Management of acute and chronic ankle instability. J Am Acad Orthop Surg 2008;16:608-15.
  • 13 Kobayashi T, Gamada K. Lateral ankle sprain and chronic ankle instability: A critical review. Foot Ankle Spec 2014;7:298-326.
  • 14 Coughlin MJ, Schenck RC Jr., Grebing BR, Treme G. Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft. Foot Ankle Int 2004;25:231-41.
  • 15 Gribble PA, Delahunt E, Bleakley CM, Caulfield B, Docherty CL, Fong DT, et al. Selection criteria for patients with chronic ankle instability in controlled research: A position statement of the International Ankle Consortium. J Athl Train 2014;49:121-7.
  • 16 Chan KW, Ding BC, Mroczek KJ. Acute and chronic lateral ankle instability in the athlete. Bull NYU Hosp Jt Dis 2011;69:17-26.
  • 17 Nitz AJ, Dobner JJ, Kersey D. Nerve injury and grades II and III ankle sprains. Am J Sports Med 1985;13:177-82.
  • 18 Helgeson K. Examination and intervention for sinus tarsi syndrome. N Am J Sports Phys Ther 2009;4:29-37.
  • 19 Odak S, Ahluwalia R, Shivarathre DG, Mahmood A, Blucher N, Hennessy M, et al. Arthroscopic evaluation of impingement and osteochondral lesions in chronic lateral ankle instability. Foot Ankle Int 2015;36:1045-9.
  • 20 Heckman DS, Gluck GS, Parekh SG. Tendon disorders of the foot and ankle, part 1: Peroneal tendon disorders. Am J Sports Med 2009;37:614-25.
  • 21 Aynardi M, Pedowitz DI, Raikin SM. Subtalar instability. Foot Ankle Clin 2015;20:243-52.
  • 22 McCriskin BJ, Cameron KL, Orr JD, Waterman BR. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations. World J Orthop 2015;6:161-71.
  • 23 Besse JL. Instabilités latérales chroniques de cheville. In: Leemrijse T, editor. Pathologie du Pied et de la Cheville. France: Elsevier Masson; 2009. p. 454-66.
  • 24 Bell SJ, Mologne TS, Sitler DF, Cox JS. Twenty-six-year results after Broström procedure for chronic lateral ankle instability. Am J Sports Med 2006;34:975-8.
  • 25 Nakata K, Shino K, Horibe S, Natsu-Ume T, Mae T, Ochi T. Reconstruction of the lateral ligaments of the ankle using solvent-dried and gamma-irradiated allogeneic fascia lata. J Bone Joint Surg Br 2000;82:579-82.
  • 26 Hua Y, Chen S, Li Y, Chen J, Li H. Combination of modified Broström procedure with ankle arthroscopy for chronic ankle instability accompanied by intra-articular symptoms. Arthroscopy 2010;26:524-8.
  • 27 Lee KT, Park YU, Kim JS, Kim JB, Kim KC, Kang SK. Long-term results after modified Brostrom procedure without calcaneofibular ligament reconstruction. Foot Ankle Int 2011;32:153-7.
  • 28 Buerer Y, Winkler M, Burn A, Chopra S, Crevoisier X. Evaluation of a modified Broström-Gould procedure for treatment of chronic lateral ankle instability: A retrospective study with critical analysis of outcome scoring. Foot Ankle Surg 2013;19:36-41.
  • 29 Watson-Jones R. Recurrent forward dislocation of the ankle joint. J Bone Jt Surg Br 1952;34:519.
  • 30 Sugimoto K, Takakura Y, Akiyama K, Kamei S, Kitada C, Kumai T. Long-term results of Watson-Jones tenodesis of the ankle. Clinical and radiographic findings after ten to eighteen years of follow-up. J Bone Joint Surg Am 1998;80:1587-96.
  • 31 Chrisman OD, Snook GA. Reconstruction of lateral ligament tears of the ankle. An experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure. J Bone Joint Surg Am 1969;51:904-12.
  • 32 Lui TH. Arthroscopic-assisted lateral ligamentous reconstruction in combined ankle and subtalar instability. Arthroscopy 2007;23:554.e1-5.
  • 33 Maiotti M, Massoni C, Tarantino U. The use of arthroscopic thermal shrinkage to treat chronic lateral ankle instability in young athletes. Arthroscopy 2005;21:751-7.
  • 34 Sammarco VJ. Complications of lateral ankle ligament reconstruction. Clin Orthop Relat Res 2001;391:123-32.