Nonoperative management of high ankle sprains may yield acceptable long-term outcomes
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Key takeaways:
- Nonoperative management of high ankle sprains may yield positive long-term outcomes.
- Patients reported acceptable functional scores at a mean follow-up of 25 years.
According to published results, patients with high ankle sprains without diastasis who were treated with nonoperative management yielded acceptable long-term outcomes with low rates of subsequent ankle injuries.
Eric D. Nussbaum, MEd, LAT, ATC, athletic trainer at University Orthopaedic Associates in Somerset, New Jersey, and colleagues from Rutgers University performed a case study of data from 31 patients who received nonoperative management of 33 high ankle sprains and had a minimum follow-up of 18 years.
According to the study, patients were treated with 4 days of immobilization in the neutral position with a posterior splint. Patients then progressed to weight-bearing as tolerated, as well as range of motion and strengthening exercises.
Nussbaum and colleagues noted mean patient age at follow-up was 45 years, while mean time from injury to follow-up was 25 years. Among the cohort, 24 patients were collegiate athletes and seven patients were high school athletes.
Overall, 42% of patients (n = 13) reported an ipsilateral ankle injury and 16% of patients (n = 5) reported undergoing ankle or Achilles surgery after their initial high ankle sprain.
At follow-up, Nussbaum and colleagues found mean Patient-Reported Outcomes Measurement Information System-10 score was 53.4 and mean self-reported foot and ankle score was 42.7.
Among the nine patients (29%) who had available radiographs at follow-up, Nussbaum and colleagues found 27% had osteoarthritis higher than Kellgren-Lawrence grade 2 and 36% had evidence of heterotopic ossification. However, they noted most cases of OA were not clinically significant.
Nussbaum and colleagues also found mean tibiofibular clear space was 4.5 mm and mean tibiofibular overlap was 7.15 mm. In addition, they noted 27% of patients demonstrated tibiotalar narrowing.
“As treatment methods such as surgery and the administration of biological adjuncts for the treatment of [high-ankle sprains] evolve, these data will serve as a comparison when assessing the longer-term outcomes of newer and more aggressive treatment regimens,” Nussbaum and colleagues wrote in the study.
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