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Mobilization within 3 weeks of surgery has been associated with improved functional outcome scores
48%
169/353
Mobilization within 3 weeks of surgery allows for quicker unrestricted return to sporting activities
11%
39/353
Mobilization greater than 3 weeks after surgery increases rate of wound complication
2%
6/353
Mobilization greater than 3 weeks after surgery increases degree of postoperative ankle laxity
7/353
There is no difference in outcomes or complication rates between rehabilitation protocols
36%
128/353
Select Answer to see Preferred Response
After lateral ankle ligament repair and retinacular imbrication (Brostrom-Gould), early mobilization <3 weeks postoperatively has been associated with improved functional outcomes scores despite increased risk of laxity and complication rates. Ankle sprains are a prevalent injury, especially in the young athletic population, and usually occur with an inverted mechanism on a plantarflexed foot. Recurrent sprains can lead to instability secondary to stretching/tearing of the lateral ankle ligaments. Typically physical therapy is utilized as the primary treatment modality with high success rates (>80%). However, persistent or recurrent instability can occur despite an appropriate trial of nonoperative management. In such cases, a Brostom-Gould procedure can be performed and has excellent results. There has been some debate regarding the rehabilitation protocol in these patients and whether there are benefits with early mobilization <3 weeks after surgery vs. delayed mobilization at >3 weeks. Several studies have demonstrated improved outcomes with early mobilization but objective ankle laxity and complication rates have also been shown to be increased in this population. Vopat et al. reviewed early versus delayed mobilization postoperative protocols for lateral ankle ligament repair. They noted that the postoperative AOFAS score was greater in the early mobilization group compared to the delayed group (98.9 vs. 91.9, respectively). This being said, the early mobilization group had greater postoperative laxity and higher rates of complications, primarily concerning wound infections. Yasui et al. reviewed surgical procedures for chronic lateral ankle instability for the JAAOS. They discuss repair vs. reconstruction, the potential benefits of both, and newer arthroscopic techniques. They also mention further research is needed to investigate the effects of lateral ankle instability and repair on ankle joint deterioration and possible development of arthritis. Incorrect Answers:Answer 2: Return to unrestricted sporting activity occurs in a similar time frame regardless of the mobilization protocol. Answer 3: Early mobilization of LESS than 3 weeks has demonstrated an increased risk of wound complication. Answer 4: Mobilization at less than 3 weeks has demonstrated an increased degree of ankle laxity both with anterior drawer and talar tilt testing. Answer 5: As noted above, early mobilization at less than 3 weeks has demonstrated improved functional outcomes but increased laxity and complication rates.
3.5
(2)
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