From “Low” to “High” Athletic Ankle Sprains: A Comprehensive Review

Generally, most Grade I-III acute lateral ligament injuries can be treated conservatively. Yet despite a propensity of research regarding ankle sprains some controversy still exists as regarding the optimum treatment of grade III injuries in athletes. Physical exercise therapy combined with progressive weight bearing is a fundamental component of the functional treatment of acute lateral ligamentous injury. Generally, early active range of motion exercises is followed by strengthening exercises, proprioception, and functional exercises. Most re-injuries are probably related to inadequate neuromuscular training during the rehabilitation phase. Treatment of grade III lateral ligament injury especially in athletes remains controversial. Reviews comparing surgery vs conservative treatment have failed to demonstrate a clearly superior method. Thus, functional treatment might be preferred over surgery in most cases. However, surgical treatment may be beneficial in certain professional athletes on an individual basis. The advantage of surgical repair is significantly less objective instability when compared to non-operative treatment and this factor has been found to be predictive for future ankle sprains. Recent arthroscopic surgical techniques have been described as part of the therapeutical options in the treatment of mainly chronic ankle instability. Also, new data on the role of the calcaneo-fibular ligament in this regard highlights key points that need to be addressed before deciding for optimal treatment.