Ankle Sprain Persisting After Extended Conservative Rehabilitation
For some patients with ankle sprain, an extended course of conservative management does not achieve adequate joint stability or restore self-reported function. This protocol addresses the step taken when that situation is confirmed — and a different approach becomes necessary.
The preceding management included high-dose neuromuscular and proprioceptive exercise training (greater than 900 minutes total) combined with ankle bracing maintained for a minimum of 6 months. Despite completing this course, the following targets were not reached within 12 months:
- Absence of recurrent ankle sprain
- Improved ankle joint subjective stability
- Improved self-reported ankle joint function
In patients with persistent symptoms following a full trial of conservative care, a surgical approach to ankle ligament repair is considered — evaluated on an individual basis. The full protocol specifies the clinical criteria and structured pathway involved.
The targets for this protocol are improved ankle joint subjective stability and improved self-reported ankle joint function.
References
DOI: 10.1136/bjsports-2016-096178
- The general consensus of the reviews that investigated a surgical intervention was that a trial of conservative treatment should always be attempted before surgery is undertaken, that surgery should be considered only in patients with persistent symptoms, and that it should be considered on an individual basis.
- Two identified that surgery had better outcomes when compared with conservative management in the treatment of acute ankle sprain.
- With respect to giving way, a significant difference was noted between operative treatment and functional treatment in favour of operative treatment.