Importance of differentiation between stable versus unstable grade II high ankle sprains
When a ligament is stretched leading to a tear, it leads to sprain. It can be majorly due to the atheletic activity. This study has been aimed to scrutinize and locate the grade II syndesmosis injuries in athletes as well as factors important in differentiating stable from dynamically unstable ankle sprains and those associated with a longer time to return to sports.
About 64 patients with an isolated syndesmosis injury (without fracture) were prospectively evaluated with a mean follow-up period of 37 months ranging from 24 to 66 months. Patients with associated deltoid ligament injury or osteochondral lesion were involved. The conservative treatment was employed to those whose injuries were considered stable (grade IIa) and rehabilitation. Also, arthroscopy was employed to those whose injuries were clinically unstable and the syndesmosis was stabilized on confirmation of instability (grade IIb). The injury to individual ligaments were assessed by the clinical and magnetic resonance imaging assessments along with time to return to play. According to a power analysis, 28 patients must be present in each group.
The athletes resumed to the same level of professional sport. 28 patients having grade IIa injuries returned at a mean of 45 days (range, 23 to 63 days) on contrary to 64 days (range, 27 to 104 days) for patients with grade IIb injuries (P< .0001). A remarkable connection was observed between clinical and magnetic resonance imaging assessments of ligament injury (anterior-inferior tibiofibular ligament [AITFL], anterior tibiofibular ligament [ATFL] and deltoid ligament, P < .0001). Instability was 9.5 times and 11 times as likely with positive squeeze test as well as deltoid injury. A delay in the return to sports was due to combined injury to the anterior-inferior tibiofibular and deltoid ligament. Syndesmosis is less likely to be unstable and is connected with an earlier return to sports as the concomitant injury to the ATFL indicated a unalike mechanism of injury.
The key factors in differentiating stable from dynamically unstable grade II injuries and may be used to detect the athletes who may be satisfied from early arthroscopic assessment and stabilization are: positive squeeze test, injury to the ATFL and deltoid ligament. These factors may also be used to predict the time frame for athletes' expected return to play.