Surgery vs conservative management for acute ankle ligament ruptures

Report By: Ian Persad - SHO Orthopaedics
Search checked by Sashi Kommu - SHO Urology/ General Surgery
Institution: Darlington Memorial Hospital
Current web editor: Minnie Alexander - Senior Information Officer
Date Submitted: 2nd March 2002
Last Modified: 11th March 2002
Status: Blue (submitted but not checked)

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
[exp ankle injuries OR ankle sprains.mp. ] AND [exp collateral ligaments/su] AND [exp bandages OR exp surgical casts]

Search Outcome

5 papers were found of which 1 paper addressed the question fully

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Munk,-B; Holm-Christensen,-K; Lind,-T Oct 1995 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.

Comment(s)

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.

Clinical 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. Acta-Orthop-Scand. 1995 Oct; 66(5):452-4.