RSS-Feed abonnieren
Bitte kopieren Sie die angezeigte URL und fügen sie dann in Ihren RSS-Reader ein.
https://www.thieme-connect.de/rss/thieme/de/10.1055-s-00000070.xml
PDF herunterladen
Semin Musculoskelet Radiol 2023; 27(03): 231-244
DOI: 10.1055/s-0043-1767767
DOI: 10.1055/s-0043-1767767
Review Article
Ankle Instability Update
Abstract
Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.
New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.
Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.
Keywords
sprain - ankle ligaments - microinstability - anterior talofibular ligament - rotatory ankle instabilityPublikationsverlauf
Artikel online veröffentlicht:
25. Mai 2023
© 2023. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Clifton DR, Koldenhoven RM, Hertel J, Onate JA, Dompier TP, Kerr ZY. Epidemiological patterns of ankle sprains in youth, high school, and college football. Am J Sports Med 2017; 45 (02) 417-425
- 2 Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of ankle sprains and chronic ankle instability. J Athl Train 2019; 54 (06) 603-610
- 3 Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med 2014; 44 (01) 123-140
- 4 Hintermann B, Ruiz R. . Lateral ankle instability. In: Hintermann B, Ruiz R, eds. Foot and Ankle Instability. Cham, Switzerland: Springer; 2021:3–61
- 5 Sofka CM. Imaging techniques for assessment of dynamically unstable sports related foot and ankle injuries. Foot Ankle Clin 2021; 26 (01) 205-224
- 6 Hintermann B. What the orthopaedic foot and ankle surgeon wants to know from MR Imaging. Semin Musculoskelet Radiol 2005; 9 (03) 260-271
- 7 Jeong MS, Choi YS, Kim YJ, Kim JS, Young KW, Jung YY. Deltoid ligament in acute ankle injury: MR imaging analysis. Skeletal Radiol 2014; 43 (05) 655-663
- 8 Alshalawi S, Galhoum AE, Alrashidi Y. et al. Medial ankle instability: the deltoid dilemma. Foot Ankle Clin 2018; 23 (04) 639-657
- 9 Machado M, Amado P, Babulal J. Ankle instability—review and new trends. J Ortho Trauma Rehabil 2021; 28
- 10 Vega J, Dalmau-Pastor M. . Anterior ankle impingement and ankle instability. In: Wagner Hitschfeld E, Wagner Hitschfeld P, eds. Foot and Ankle Disorders. Cham, Switzerland: Springer; 2022:1045–1064
- 11 Lee J, Hamilton G, Ford L. Associated intra-articular ankle pathologies in patients with chronic lateral ankle instability: arthroscopic findings at the time of lateral ankle reconstruction. Foot Ankle Spec 2011; 4 (05) 284-289
- 12 Pereira H, D'Hooghe P, Hunt KJ, Kynsburg A, Pereira de Castro A, Jones H. . Concurrent pathology and ankle instability. In: Pereira H, Guillo S, Glazebrook M, et al, eds. Lateral Ankle Instability. Berlin, Germany: Springer; 2021:339–355
- 13 Golanó P, Vega J, de Leeuw PAJ. et al. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 2010; 18 (05) 557-569
- 14 Flores DV, Mejía Gómez C, Fernández Hernando M, Davis MA, Pathria MN. Adult acquired flatfoot deformity: anatomy, biomechanics, staging, and imaging findings. Radiographics 2019; 39 (05) 1437-1460
- 15 Ziai P, Benca E, von Skrbensky G. et al. The role of the peroneal tendons in passive stabilisation of the ankle joint: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2013; 21 (06) 1404-1408
- 16 Ziai P, Benca E, Wenzel F. et al. Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners. Knee Surg Sports Traumatol Arthrosc 2016; 24 (04) 1175-1179
- 17 Crim J. Medial-sided ankle pain: deltoid ligament and beyond. Magn Reson Imaging Clin N Am 2017; 25 (01) 63-77
- 18 Crim JR, Beals TC, Nickisch F, Schannen A, Saltzman CL. Deltoid ligament abnormalities in chronic lateral ankle instability. Foot Ankle Int 2011; 32 (09) 873-878
- 19 Szaro P, Gataa KG, Polaczek M, Ciszek B. The flexor retinaculum connects the surrounding structures into the medial ankle complex. Appl Sci (Basel) 2020; 10 (22) 1-13
- 20 Numkarunarunrote N, Malik A, Aguiar RO, Trudell DJ, Resnick D. Retinacula of the foot and ankle: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol 2007; 188 (04) W348-54
- 21 Crim J, Longenecker LG. MRI and surgical findings in deltoid ligament tears. AJR Am J Roentgenol 2015; 204 (01) W63-9
- 22
Milner CE,
Soames RW.
Anatomy of the collateral ligaments of the human ankle joint. Foot Ankle Int 1998;
19 (11) 757-760
MissingFormLabel
- 23 van den Bekerom MP, Oostra RJ, Golanó P, van Dijk CN. The anatomy in relation to injury of the lateral collateral ligaments of the ankle: a current concepts review. Clin Anat 2008; 21 (07) 619-626
- 24 Dalmau-Pastor M, Malagelada F, Calder J, Manzanares MC, Vega J. The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments. Knee Surg Sports Traumatol Arthrosc 2020; 28 (01) 34-39
- 25 Vega J, Malagelada F, Manzanares Céspedes MC, Dalmau-Pastor M. The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure. Knee Surg Sports Traumatol Arthrosc 2020; 28 (01) 8-17
- 26 Vega J, Montesinos E, Malagelada F, Guelfi M, Baduell A, Dalmau-Pastor M. . Microinstability of the ankle. In: Pereira H, Guillo S, Glazebrook M, et al, eds. Lateral Ankle Instability. Berlin, Germany: Springer; 2021:55–62
- 27 Boss AP, Hintermann B. Anatomical study of the medial ankle ligament complex. Foot Ankle Int 2002; 23 (06) 547-553
- 28 Hintermann B, Golanó P. The anatomy and function of the deltoid ligament. Tech Foot Ankle Surg 2014; 13 (02) 67-72
- 29 Hintermann B, Knupp M, Pagenstert GI. Deltoid ligament injuries: diagnosis and management. Foot Ankle Clin 2006; 11 (03) 625-637
- 30 Hintermann B, Valderrabano V, Boss A, Trouillier HH, Dick W. Medial ankle instability: an exploratory, prospective study of fifty-two cases. Am J Sports Med 2004; 32 (01) 183-190
- 31 Mengiardi B, Pfirrmann CW, Vienne P, Hodler J, Zanetti M. Medial collateral ligament complex of the ankle: MR appearance in asymptomatic subjects. Radiology 2007; 242 (03) 817-824
- 32 Mengiardi B, Pinto C, Zanetti M. Spring ligament complex and posterior tibial tendon: MR anatomy and findings in acquired adult flatfoot deformity. Semin Musculoskelet Radiol 2016; 20 (01) 104-115
- 33
Kofotolis ND,
Kellis E,
Vlachopoulos SP.
Ankle sprain injuries and risk factors in amateur soccer players during a 2-year period.
Am J Sports Med 2007; 35 (03) 458-466
MissingFormLabel
- 34 Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med 2007; 37 (01) 73-94
- 35 Buchhorn T, Sabeti-Aschraf M, Dlaska CE, Wenzel F, Graf A, Ziai P. Combined medial and lateral anatomic ligament reconstruction for chronic rotational instability of the ankle. Foot Ankle Int 2011; 32 (12) 1122-1126
- 36 Vega J, Allmendinger J, Malagelada F, Guelfi M, Dalmau-Pastor M. Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28 (01) 132-140
- 37 Ikuta Y, Nakasa T, Sumii J, Nekomoto A, Adachi N. Quantitative analysis of deltoid ligament degradation in patients with chronic ankle instability using computed tomographic images. Foot Ankle Int 2021; 42 (07) 952-958
- 38 Vega J, Peña F, Golanó P. Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain. Knee Surg Sports Traumatol Arthrosc 2016; 24 (04) 1116-1123
- 39 Vega J, Malagelada F, Dalmau-Pastor M. Ankle microinstability: arthroscopic findings reveal four types of lesions to the anterior talofibular ligament's superior fascicle. Knee Surg Sports Traumatol Arthrosc 2021; 29 (04) 1294-1303
- 40 Lee JC, Mitchell AWM, Pesquer L. . Lateral ankle instability imaging. In: Pereira H, Guillo S, Glazebrook M, et al, eds. Lateral Ankle Instability. Berlin, Germany: Springer; 2021:45–61
- 41 Salat P, Le V, Veljkovic A, Cresswell ME. Imaging in foot and ankle instability. Foot Ankle Clin 2018; 23 (04) 499-522.e28
- 42 Jung HG, Kim NR, Kim TH, Eom JS, Lee DO. Magnetic resonance imaging and stress radiography in chronic lateral ankle instability. Foot Ankle Int 2017; 38 (06) 621-626
- 43 Jolman S, Robbins J, Lewis L, Wilkes M, Ryan P. Comparison of magnetic resonance imaging and stress radiographs in the evaluation of chronic lateral ankle instability. Foot Ankle Int 2017; 38 (04) 397-404
- 44 Kakegawa A, Fukushima N, Sumitomo N, Nagira A, Ichinose Y. Difference in the fibular attachment structure between the superior and inferior fascicles of the anterior talofibular ligament using ultrasonography and histological examinations. Surg Radiol Anat 2022; 44 (12) 1513-1520
- 45 Li H, Hua Y, Feng S, Li H, Chen S. Lower signal intensity of the anterior talofibular ligament is associated with a higher rate of return to sport after ATFL repair for chronic lateral ankle instability. Am J Sports Med 2019; 47 (10) 2380-2385
- 46 Alparslan L, Chiodo CP. Lateral ankle instability: MR imaging of associated injuries and surgical treatment procedures. Semin Musculoskelet Radiol 2008; 12 (04) 346-358
- 47 Vega J, Guelfi M. Arthroscopic assessment and treatment of medial collateral ligament complex. Foot Ankle Clin 2021; 26 (02) 305-313
- 48 Cerezal L, Llopis E, Canga A, Rolón A. MR arthrography of the ankle: indications and technique. Radiol Clin North Am 2008; 46 (06) 973-994 , v
- 49 Taljanovic MS, Alcala JN, Gimber LH, Rieke JD, Chilvers MM, Latt LD. High-resolution US and MR imaging of peroneal tendon injuries. Radiographics 2015; 35 (01) 179-199
- 50 Rosenberg ZS, Bencardino J, Astion D, Schweitzer ME, Rokito A, Sheskier S. MRI features of chronic injuries of the superior peroneal retinaculum. AJR Am J Roentgenol 2003; 181 (06) 1551-1557
- 51 Raikin SM, Elias I, Nazarian LN. Intrasheath subluxation of the peroneal tendons. J Bone Joint Surg Am 2008; 90 (05) 992-999
- 52 Danna NR, Brodsky JW. Diagnosis and operative treatment of peroneal tendon tears. Foot Ankle Orthop 2020; 5 (02) 2473011420910407
- 53 Bencardino J, Rosenberg ZS, Beltran J. et al. MR imaging of dislocation of the posterior tibial tendon. AJR Am J Roentgenol 1997; 169 (04) 1109-1112
- 54 Jackson LT, Dunaway LJ, Lundeen GA. Acute tears of the tibialis posterior tendon following ankle sprain. Foot Ankle Int 2017; 38 (07) 752-759
- 55 Lewis SD, Chew FS. Ankle medial flexor retinaculum avulsion fracture. Radiol Case Rep 2019; 14 (09) 1144-1147
- 56 Goucher NR, Coughlin MJ, Kristensen RM. Dislocation of the posterior tibial tendon: a literature review and presentation of two cases. Iowa Orthop J 2006; 26: 122-126
- 57 Gyftopoulos S, Woertler K. . Ankle and foot. In: Hodler J, Kubik-Huch RA, von Schulthess GK, eds. Musculoskeletal Diseases 2021–2024: Diagnostic Imaging. Cham, Switzerland: Springer; 2021:107–120
- 58 Elias I, Zoga AC, Morrison WB, Besser MP, Schweitzer ME, Raikin SM. Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 2007; 28 (02) 154-161
- 59 Griffith JF, Lau DT, Yeung DK, Wong MW. High-resolution MR imaging of talar osteochondral lesions with new classification. Skeletal Radiol 2012; 41 (04) 387-399
- 60 Batista J, Matías-Joannas G, Casola L, Logioco L, Arrondo G. New classification of osteochondral lesions of the talus in adults. Journal of the Foot & Ankle 2021; 15 (01) 77-82
- 61 Loomer R, Fisher C, Lloyd-Smith R, Sisler J, Cooney T. Osteochondral lesions of the talus. Am J Sports Med 1993; 21 (01) 13-19
- 62 Watson AD. Ankle instability and impingement. Foot Ankle Clin 2007; 12 (01) 177-195
- 63 Cerezal L, Abascal F, Canga A. et al. MR imaging of ankle impingement syndromes. AJR Am J Roentgenol 2003; 181 (02) 551-559
- 64 Robinson P, White LM. Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radiographics 2002; 22 (06) 1457-1469 ; discussion 1470–1471
- 65 Lima CMAO, Ribeiro EB, Coutinho EPD, Vianna EM, Domingues RC, Coutinho Jr AC. Magnetic resonance imaging of ankle impingement syndrome: iconographic essay. Radiol Bras 2010; 43 (01) 53-57
- 66 Diniz P, Sousa DA, Batista JP, Abdelatif N, Pereira HJ. Diagnosis and treatment of anterior ankle impingement: state of the art. ISAKOS 2020; 5: 295-303
- 67 Al-Riyami AM, Tan HK, Peh WCG. Imaging of ankle impingement syndromes. Can Assoc Radiol J 2017; 68 (04) 431-437
- 68 Pereira VF, Gonçalves JP, Neves CMC. et al. Posterior ankle impingement syndrome in athletes: surgical outcomes of a case series. Scientific Journal of the Foot & Ankle 2019; 13 (01) 15-21
- 69 Gorbachova T, Melenevsky YV, Latt LD, Weaver JS, Taljanovic MS. Imaging and treatment of posttraumatic ankle and hindfoot osteoarthritis. J Clin Med 2021; 10 (24) 5848
- 70 Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 1976; 58 (03) 356-357
- 71 Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train 2002; 37 (04) 364-375
- 72 Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train 2019; 54 (06) 572-588
- 73 Delco ML, Kennedy JG, Bonassar LJ, Fortier LA. Post-traumatic osteoarthritis of the ankle: a distinct clinical entity requiring new research approaches. J Orthop Res 2017; 35 (03) 440-453
- 74 Taga I, Shino K, Inoue M, Nakata K, Maeda A. Articular cartilage lesions in ankles with lateral ligament injury. An arthroscopic study. Am J Sports Med 1993; 21 (01) 120-126 ; discussion 126–127
- 75 Sugimoto K, Takakura Y, Okahashi K, Samoto N, Kawate K, Iwai M. Chondral injuries of the ankle with recurrent lateral instability: an arthroscopic study. J Bone Joint Surg Am 2009; 91 (01) 99-106
- 76 Lopez-Ben R. Imaging of the subtalar joint. Foot Ankle Clin 2015; 20 (02) 223-241
- 77 Clanton TO, Chacko AK, Matheny LM, Hartline BE, Ho CP. Magnetic resonance imaging findings of snowboarding osteochondral injuries to the middle talocalcaneal articulation. Sports Health 2013; 5 (05) 470-475
- 78 Angthong C, Veljkovic A, Angthong W, Rajbhandari P. Talar-sided osteochondral lesion of the subtalar joint following the intra-articular calcaneal fracture: study via a modified computed tomography mapping analysis. Eur J Orthop Surg Traumatol 2019; 29 (06) 1331-1336