ANKLE & KNEE SPRAINS

Ligament injuries occur in most ball and jumping sports. The lateral ligament complex is composed of three ligaments, the anterior talofibular ligament (ATFL), the calcano fibular ligament (CFL), and the posterior talofibular ligament (PTFL). The soft tissue structure of the ankle is maintained by the 3 groups of ligaments, the lateral ligaments, the deltoid ligament and the syndesmosis complex.

MECHANISM OF INJURY

The most common mechanism of injury at the ankle is an inward turning of the sole of the foot (supination/inversion). Depending on the force and degree of movement different injuries can occur, such as:

  1. Damage and tearing of the ligament between the talus and fibular bones (the anterior talofibular ligament)
  2. Avulsion fracture (pulling away a small piece of bone) of the fibular
  3. Fracture of the fibular at the joint line level
  4. More serious ankle fractures.

Ligament injury is usually (⅔ of cases) isolated to the ATFL. A combination of ATFL and CFL ruptures occur in 20-25%. The PTFL is rarely injured. The deltoid (medial) ligament and syndesmosis are usually only ruptured in severe trauma and in combination with fractures.

CLASSIFICATION

Grade I – Ligament stretch without tearing, minimal swelling or tenderness, minimal functional loss, no
mechanical joint instability.

Grade II – Partial microscopic ligament tear with moderate pain, swelling and tenderness over the involved structures. Some loss of joint motion and mild to moderate joint instability.

Grade III – Complete ligament rupture with marked swelling, haemorrhage and tenderness. Loss of function and severe instability. Difficult fully weight bearing.

MANAGEMENT & TREATMENT

First 48 hours:

P.R.I.C.E principles are applied
Gentle active range of motion exercises
Avoid painful activities
Weight bearing with a brace or other stabilizing support
X-rays are rarely done unless bony injury is suspected

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After 48 hours:

Continue with range of motion exercises and weight bearing as pain allows.
Assessment by a qualified therapist to assess the degree of damage is recommended.
Proprioceptive exercises and strengthening exercises as instructed by your therapist.

HEALING

A general rule of thumb will be:

Grade I injury; 1 – 2 weeks
Grade II injury; 2 – 4 weeks
Grade III injury; 4 – 8 weeks

However problems may remain for 6-9 months. Return to maybe anything from 4 – 12 weeks dependent on the sport and extent of the injury. (Be guided by your therapist).