Surgery vs conservative management for acute ankle ligament ruptures
Date First Published:
March 2, 2002
Last Updated:
March 11, 2002
Report by:
Ian Persad, SHO Orthopaedics (Darlington Memorial Hospital)
Search checked by:
Sashi Kommu, Darlington Memorial Hospital
Three-Part Question:
In [ patients with acute ankle ligament ruptures ] is [ surgery better than conservative management ] at [ reducing complications ]
Clinical Scenario:
A 25 year old male sustains an inversion ankle injury while playing football. Clinical examination and radiographic studies confirm an acute ligament rupture. You wonder whether this patient should be treated conservatively or admitted for surgical repair.
Search Strategy:
MEDLINE 1966 to 03/2002, using OVID
Search Details:
[exp ankle injuries OR ankle sprains.mp. ] AND [exp collateral ligaments/su] AND [exp bandages OR exp surgical casts]
Outcome:
5 papers were found of which 1 paper addressed the question fully
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Long term outcome after ruptured lateral ankle ligaments. A prospective study of 3 different treatments in 79 patients with 11 year follow-up. Munk,-B; Holm-Christensen,-K; Lind,-T. Oct-95 Scandinavia | 79 pts. with arthrographically verified acutely ruptured lateral ligament injuries evaluated with 3 diff. treatments: operation and walking cast for 5 weeks, walking cast alone and elastic bandage followed over a 11 year period. | PROSPECTIVE RANDOMISED | Residual diabilities, instability, pain on activity and number of ligament reconstructions and talocrural arthroses | were all equally low in the 3 Groups | Relatively small sample size. Only lateral ankle ligaments were considered in this study. |
Author Commentary:
This area of management of ankle injuries remains to be studied further. There is only one study that addresses the issue questioned. However, the paper scrutinized seems to suggest that there is no significant difference in the outcomes.
Bottom Line:
From the results of our search the evidence at hand seems to suggest that non-operative management seems adequate.
References:
- Munk,-B; Holm-Christensen,-K; Lind,-T.. Long term outcome after ruptured lateral ankle ligaments. A prospective study of 3 different treatments in 79 patients with 11 year follow-up.