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World J Orthop. Mar 18, 2015; 6(2): 161-171
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.161
Management and prevention of acute and chronic lateral ankle instability in athletic patient populations
Brendan J McCriskin, Kenneth L Cameron, Justin D Orr, Brian R Waterman
Brendan J McCriskin, Kenneth L Cameron, Justin D Orr, Brian R Waterman, Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, TX 79920, United States
Kenneth L Cameron, the John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, US Military Academy, West Point, NY 10996, United States
Author contributions: All authors contributed equally to this work.
Conflict-of-interest: I declare that I have no conflicts of interest in the authorship or publication of this contribution.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Brian R Waterman, MD, MC, Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, 5005 North Piedras St, El Paso, TX 79920, United States.
Telephone: +1-915-7421833 Fax: +1-915-7421931
Received: December 29, 2013
Peer-review started: December 31, 2013
First decision: January 20, 2014
Revised: November 16, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: March 18, 2015

Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.

Keywords: Ankle instability, Athlete, Treatment, Epidemiology, Prevention, Lateral, Sprain

Core tip: Competitive athletes and high-demand military servicemembers are at significant risk for lateral ankle instability during at-risk activity, particularly in the presence of certain modifiable and non-modifiable risk factors. In conjunction with semirigid ankle bracing, functional rehabilitation protocols emphasizing neuromuscular coordination, peroneal strengthening, and proprioceptive training are effective for the majority of patients with acute ankle sprain. However, with chronic lateral ankle instability unresponsive to conservative measures, anatomic ligamentous repair or reconstruction reliably restores active patients to full athletic function. Prophylactic bracing and targeted physical therapy may also be considered in selected, high-risk cohorts.