Arthroscopic Assessment for Intra-articular Disorders in Residual Ankle Disability After Sprain

• Published in: The American journal of sports medicine 2005-05, Vol.33 (5), p.686-692
• Main Authors: Takao, Masato, Uchio, Yuji, Naito, Kohei, Fukazawa, Ikuo, Ochi, Mitsuo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Ankle; Ankle injuries; Ankle Injuries - complications; Ankle Injuries - diagnosis; Ankle Injuries - surgery; Arthroscopy; Arthroscopy - methods; Athletes; Biological and medical sciences; Bone Screws; Bone Wires; Care and treatment; Cohort Studies; Diagnosis, Differential; Double-Blind Method; Endoscopic surgery; Female; Fundamental and applied biological sciences. Psychology; Health aspects; Humans; Injuries; Injuries of the limb. Injuries of the spine; Joint and ligament injuries; Joints; Knee; Ligaments, Articular - injuries; Ligaments, Articular - surgery; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Orthopedic Procedures - instrumentation; Orthopedic Procedures - methods; Osteochondritis - classification; Osteochondritis - etiology; Pain - etiology; Physical Examination; Sport (general aspects); Sports injuries; Sports medicine; Sprains and Strains - complications; Sprains and Strains - diagnosis; Sprains and Strains - surgery; Stress, Mechanical; Synovitis - etiology; Traumas. Diseases due to physical agents; Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546504270566

Background: After ankle sprain, there can be many causes of disability, the origins of which cannot be determined using standard diagnostic tools. Hypothesis: Ankle arthroscopy is a useful tool in identifying intra-articular disorders of the talocrural joint in cases of residual ankle disability after sprain. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The authors gathered the independent diagnostic results of physical examination, standard mortise and lateral radiography, stress radiography of the talocrural joint, and magnetic resonance imaging for 72 patients with residual ankle disability lasting more than 2 months after injury (mean, 7 months after injury). They performed arthroscopic procedures and compared the double-blind results. Results: In all cases, the arthroscopic results matched those of other means of diagnosis. In 14 cases, the arthroscopic approach exceeded the capabilities of the other methods. Including duplications, 39 patients (54.2%) had anterior talofibular ligament injuries, 17 patients (23.6%) had distal tibiofibular ligament injuries, 29 patients (40.3%) had osteochondral lesions, 13 patients (18%) had symptomatic os subfibulare, 3 patients (4.2%) had anterior impingement exostosis, and 3 patients (4.2%) had impingement due to abnormally fibrous bands. There were only 2 cases in which the cause of symptoms could not be detected by ankle arthroscopy, compared with 16 cases in which the cause of disability could not be detected using standard methods. In 3 cases (17.6%) of distal tibiofibular ligament injuries, 8 cases (27.6%) of osteochondral lesions, and all 3 cases (100%) of impingement of an abnormal fibrous band, ankle arthroscopy was the only method capable of diagnosing the cause of residual ankle pain after a sprain. Conclusion: The present results suggest that arthroscopy can be used to diagnose the cause of residual pain after an ankle sprain in most cases that are otherwise undiagnosable by clinical examination and imaging study. Keywords: ankle arthroscopy sprain residual disability