Chronic Lateral Ankle Instability (Continued)

Ligament injuries are different because most of them do not totally heal. Even if the pain resolves, the ligament will not be as strong as it was prior to the injury. Since ligaments stabilize the joints, by definition ligament injury produces a loose joint. If the ligament never heals, chronic joint looseness or instability results. The symptoms of chronic ankle instability are feelings of the joint giving way, swelling, pain, decreased range of motion or excessive motion, and recurring sprains. The pain is usually chronic or recurrent. Other symptoms include complaints while wearing high heels, increased symptoms after walking or sports, and, as stated, recurrent sprains.23,24,25,26

If the ankle instability is not treated, cartilage deterioration with resultant degenerative arthritis develops. This sequence of events occurs everywhere in the body. If a ligament does not heal, instability of the joint occursùand the end-result is arthritis with good prospects for fusion or joint replacement surgery.

Studies on injured ligaments show that at least one year is required before healing has been completed or the total amount of healing occurs.27 Injured ligaments do not entirely regenerate. Rather, they repair with scar tissue. Repair and regeneration begin at 48 hours to 72 hours post-injury, and continue maximally for six weeks.

From six weeks to 12 months the ligament tissue remodels, contracts, and gains tensile strength. After 12 months the ligament and scar tissue generally matures and achieves 50 to 70 percent strength of the original ligament.27 Do you understand the magnitude of this statement? On average, ligaments only heal to 50 to 70 percent strength when they are injured.

Pain relief is not a reliable sign that a ligament has healed; perfect function is the sign. A joint that is strong, without swelling or signs of weakness, is a better measure.

What are the options?

There are many treatment options available to the athlete and these should be discussed with a qualified health care provider. The traditional treatments for unresolved ankle pain are arthroscopy and/or ankle fusion. For those seeking non-surgical alternatives various articles from this author are available at the following links:

Twisted Ankle
Ankle Fusion
Chronic Ankle Pain in a Female Athlete
Golf, Prolotherapy and Weak Ankles

23. DeMaio, M. Chronic lateral ankle instability-inversion sprains: Part II. Orthopedics. 1992; 15:241-248.
24. Freeman, M. Treatment of ruptures of the lateral ligament of the ankle. Journal of Bone and Joint Surgery. 1965; 47B:661-668.
25. Cass, J. Ankle instability: current concepts, diagnosis, and treatment. Mayo Clinic Proceedings. 1984; 59:165-170.
26 Andriacchi, T. Injury and Repair of the Musculoskeletal Soft Tissues. Park Ridge, IL: AAOS; 1987; 103-108.
27. Andriacchi, T. Injury and Repair of the Musculoskeletal Soft Tissues. Park Ridge, IL: AAOS; 1987; 103-108.

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