Abstract
Background:
Children experience the highest incidence of ankle sprains, most affecting the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Acute ankle sprains are associated with an increased risk of recurrence. Research has shown conservative and surgical treatment have similar time till return to pre-injury activities and symptoms at one year or more follow up. However, there is little literature demonstrating the efficacy of surgical reconstruction vs. conservative treatment in reducing ankle sprain recurrence.
Hypothesis:
Surgical treatment of lateral ankle sprains reduces the recurrent ankle sprain rate when compared to conservative treatment.
Methods:
Patients seen at a single, large university affiliated children’s hospital with an ATFL tear confirmed on MRI within 6 months of an ankle sprain diagnosis were identified. Retrospective review was performed to characterize the primary sprain diagnosed on MRI, treatment plans, and any recurrent sprains. Descriptive analyses were completed to determine the recurrence rate of ankle sprains.
Results:
145 patients were included in the study. The mean age at the sprain of interest for which MRI was obtained was 15.27 years with 76.39% of ankle sprains occurring during sports. Recurrent sprains of any type occurring before or after the sprain of interest were recorded in 60.69% of patients, with the majority of sprains (82.95%) affecting the ipsilateral ankle and occurring prior to the sprain of interest (69.77%). Patients who attended physical therapy for this focal sprain had similar rates of recurrent sprains to those who did not have recurrent sprains (p= 0.5121). No difference was found in sports participation rates between those with and without recurrent ankle sprains (p= 0.3612). 9.66% of the patients underwent ATFL reconstruction. Patients who experienced recurrent sprains before or after the focal sprain did not undergo surgical reconstruction at a higher rate as compared to those who did not have recurrent sprains (p= 0.3752). Among patients who had recurrent sprains before or after the focal sprain, there was no difference between the rate of ipsilateral sprains and treatment received (p= 0.1992). Further, among those with recurrent sprains, the rates of sprains before and after the focal sprain were comparable between treatment groups (p= 0.481).
Conclusion:
Ankle sprain injuries increase the risk for recurrent sprains. Most recurrent sprains occurred before the focal sprain. Recurrence rates of ankle sprains after the focal sprain did not differ between treatment groups. These results suggest that recurrent ankle sprains occur at similar rates after surgical reconstruction vs. conservative treatment.
