Rupture of the lateral ligaments of the ankle: a controlled clinical trial. Comparison of three different treatments for ruptured lateral ankle ligaments. Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial. Injuries of the lateral ligament of the ankle. Conservative vs. operative repair. A prospective study of the treatment of severe tears of the lateral ligament of the ankle. A comparison of surgical and conservative treatment in ankle ligament tears. [Therapy of injuries of the exterior ankle joint ligaments. Randomized study of postoperative therapy and early functional treatment tactics]. [Lesions of the lateral ligament of the ankle joint]. [Conservative functional treatment of fibular capsule ligament rupture even in the performance athlete?]. A randomized, prospective study of operative and non-operative treatment of injuries of the fibular collateral ligaments of the ankle. [Treatment of lateral ligament rupture of the ankle. Prospective comparison of operative and conservative treatment]. [Surgical or conservative treatment of recent rupture of the lateral ligament of the upper ankle joint. Randomized clinical study]. [Therapy of fresh fibular ligament ruptures].
The results of a randomized study comparing three different principles of treatment for rupture of the lateral ligaments of the ankle are presented. A total of 95 patients was treated and followed up for 17 months. In this series, 32 patients were treated with primary suture and plaster-of-Paris, 33 patients with plaster-of-Paris only and 30 patients with strapping. In all, 31 patients (97%) were completely free of symptoms in the operation group, 22 (67%) in the plaster-of-Paris group and 23 (77%) in the strapping group. Two hundred consecutive patients with arthrographically verified rupture of one or both of the lateral ankle ligaments were allocated to treatment with either an operation and a walking cast, walking cast alone, or strapping with an inelastic tape - all for 5 weeks. Eighty-seven percent of the patients attended follow-up after 1 year. Only 5 percent in each treatment group were unsatisfied with the result. There were no differences between the treatment groups in ankle stability or symptoms during different activities, regardless of rupture of the anterior talofibular ligament alone or combined with rupture of the calcaneofibular ligament. However, the patients treated with tape had fewer symptoms, fewer complaints when running, and more ankles recovered to the preinjury state. Therefore, in lateral ankle ligament rupture, tape bandages seem preferable. Consecutive patients with a confirmed rupture of at least one of the lateral ligaments of the ankle were randomly assigned to receive either operative or functional treatment. They were evaluated at a median of 8 years (6 to 11). In total, 370 patients were included. Follow-up was available for 317 (86%). Fewer patients allocated to operative treatment reported residual pain compared with those who had been allocated to functional treatment (16% versus 25%, RR 0.64, CI 041 to 1.0). Fewer surgically-treated patients reported symptoms of giving way (20% versus 32%, RR 0.62, CI 0.42 to 0.92) and recurrent sprains (22% versus 34%, RR 0.66, CI 0.45 to 0.94). The anterior drawer test was less frequently positive in surgically-treated patients (30% versus 54%, RR 0.54, CI 0.41 to 0.72). The median Povacz score was significantly higher in the operative group (26 versus 22, p < 0.001). Compared with functional treatment, operative treatment gives a better long-term outcome in terms of residual pain, recurrent sprains and stability. nan A prospective randomized clinical study was undertaken to compare bandaging, plaster cast immobilisation and operative treatment for recent tears of the lateral ligament of the ankle. The follow-up period was two years. Subjectively, only the fear of giving-way showed a clear difference in favour of operative repair. Objective evaluation, including stress radiographs, demonstrated no statistical differences between the three methods of treatment. Although bandaging appeared somewhat less satisfactory with respect to the resulting stability of the ankle, the differences were not statistically significant. The lateral ligament in patients over 40 years of age showed a statistically significant tendency to heal less well than that of younger patients. Severe ankle sprains in patients under 40 years of age should preferably be treated by operation, especially in younger patients and if the person is physically active. Lateral ligament tears in patients over 40 years of age should be treated conservatively and a secondary reconstruction carried out later, if necessary. Good results have been reported after both primary repair and conservative management of grade III ankle sprains. This prospective study found no advantage of operative treatment compared to taping; no significant differences were found between the groups with regard to objective or subjective stability, functional scores, or the overall result. nan nan In a prospective randomised study we examined 80 men and women of 18 to 45 years of age and 40 competitive sportsmen and sportswomen with fresh ruptures of the talofibular and calcaneofibular ligaments treated either surgically or conservatively by functional bracing. We controlled the results by anamnesis and by clinical and radiological follow-up. Conservative treatment leads to the same results after 3-8 months as surgical treatment (5 +/- 2 degrees of talar angulation). Functional conservative treatment results in earlier painless weight bearing in comparison to the surgical treatment which was, however, combined with three weeks immobilization directly after surgery. This proves the superiority of the early functional conservative treatment as long as there are no bony capsuloligamentous tears, osseocartilaginous lesions of the joint surface with splintered-off chips or "flakes" of cartilage ("flake fractures") or reruptures of a chronically unstable ankle joint. The similarly good results achieved in the group of 40 sportsmen and sportswomen by early functional conservative treatment do not justify operation of ruptures of the talofibular and calcaneofibular ligaments. One hundred and forty-six adults who had an isolated injury of the fibular collateral ligaments of the ankle were randomized to be managed operatively or non-operatively. Disruption of the ligaments was diagnosed by means of a physical examination and on the basis of stress radiographs of the ankle made with use of a specially designed device to hold the leg. Operative treatment, performed in seventy-three patients, consisted of suture repair of the disrupted ligaments within seventy-two hours after the injury, followed by immobilization of the ankle in a below-the-knee plaster cast for six weeks. Non-operative treatment, used for seventy-three patients, consisted of the use of an ankle orthosis for six weeks. After a minimum of two years of follow-up, we could detect no significant differences, with the numbers available, between the two groups with regard to the functional result or the degree of joint laxity that was evident on stress radiographs. The non-operative group lost a mean of 1.6 weeks from work, and the operative group lost a mean of 7.0 weeks. We concluded that non-operative treatment of an injury of the fibular collateral ligaments of the ankle yields results that are comparable with those of operative repair and is associated with a shorter period of recovery. nan nan In a prospective, random study carried out at the Casualty Clinic of the University Hospital of Hannover from 15 April 1986 to 31 July 1986, 200 patients were randomly selected from four treatment groups, according to treatment: operative-immobilized (group A, n = 52), operative-functional (group B, n = 50), conservative-immobilized (group C, n = 48) and conservative-functional (group D, n = 50). Follow-up examinations were made in 92.5% of patients after 3 months and 64% after 12 months. At the 3-month and 1-year follow-ups, no statistically significant differences were found in the total evaluation (100-point checklist) Moderately significant instability (6 degrees -10 degrees talar tilt and 6-10 mm anterior talar dislocation) in the conservative groups C and D was observed only in the clinical-radiological instability test. This statistically significant difference is, however, only evident in stress tenographically confirmed dual-ligament lesions. No functional physiological differences can be found after 12 months; on average, the period of incapacitation is 3 weeks shorter than with primary functional treatment, but so far there are no long-term results. Until late results are available, we conclude that conservative treatment, even for professional athletes, can be recommended as the procedure most free of risk and most economical; if at all, operative therapy should only be carried out when the instability is very serious.
There is insufficient evidence available from randomised controlled trials to determine the relative effectiveness of surgical and conservative treatment for acute injuries of the lateral ligament complex of the ankle. High quality randomised controlled trials of primary surgical repair versus the best available conservative treatment for well-defined injuries are required.